Oregon health Q&A: Any help for Medicare Advantage customers after Aetna, Providence split? – OregonLive

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• Oregon Health Authority

Questions are answered by experts at the Oregon Health Authority, other state agencies or community partners. Questions and answers republished by permission.

Q: Aetna will no longer cover Providence Medical Group providers, because they are considered “out-of-network.” What Primary Care Providers (PCP) in Southern Oregon are accepting new patients with Aetna’s Medicare Advantage Plans? – Bylle, Jacksonville

A: Bylle, this is definitely a problem for Aetna’s Medicare Advantage plan members in many parts of the state. Aetna has a webpage dedicated to this development, which is due to a failure between the two parties to reach agreement on a new contract. As a result, Providence providers in most parts of the state are no longer “in-network” for Aetna Medicare plans as of Dec. 31, 2024. And as you point out, Providence providers in Jackson and Josephine counties will no longer be in-network as of Feb. 17.

Aetna is sending letters to its Medicare Advantage plan members offering assistance in finding new providers and inviting them to call the number on the back of their Aetna ID card. For those currently receiving treatment from a Providence provider, the letters will outline how to request “transition of care” coverage to continue receiving that care from the same provider, covered at the in-network benefit level for a period of time, pending Aetna approval. Medicare members will have 90 days (from the day their provider became out-of-network) to request transition of care. Learn more here.

You can also use this Aetna search tool to look for a primary care provider that is accepting new patients in your area. Enter your ZIP code and county, but when you get to the “Find Care” page, I recommend entering Medford as the location. I got many more local results that way. Being open to seeing a nurse practitioner (NP) versus a doctor (MD) will also yield more options.

Q: How does an amputee on the Oregon Health Plan (OHP) find a doctor to help with prosthesis? – Ginny, Milwaukie

A: As with most OHP benefits and services, the best way to find needed care, including amputee-related care, is to contact one’s coordinated care organization (CCO). For example, in Milwaukie (Clackamas County), an OHP member’s CCO is either Health Share of Oregon (503-416-8090) or Trillium Community Health Plan (877-600-5472).

One can also use the online provider search tools for Health Share and Trillium, entering “prosthetics” as a keyword.

If an OHP member doesn’t know their CCO, they can call OHP client services at 800-273-0557 for help.

If you have questions about health topics for the Oregon Health Authority, submit your question here. Although the agency is unable to answer every question, it will try to address those of interest to a broad audience. Please understand that OHA is unable to provide specific medical advice for personal medical conditions.