Experts from the Oregon Health Authority, other state organizations, or community partners respond to inquiries. Republished with permission are the questions and answers.
Q: Because Providence Medical Group providers are deemed to be out-of-network, Aetna will no longer cover them. Which Southern Oregon primary care physicians (PCPs) are taking on new clients under Aetna’s Medicare Advantage Plans?Jacksonville’s Bylle
A: Bylle, in many areas of the state, this is undoubtedly an issue for members of Aetna’s Medicare Advantage plan. Due to the two sides’ inability to agree on a new contract, Aetnah maintains a webpage devoted to this development. As a result, as of December 31, 2024, Providence providers across the majority of the state are no longer covered by Aetna Medicare plans. You also mention that as of February 17, Providence providers in Jackson and Josephine counties would no longer be in-network.
Members of Medicare Advantage plans are receiving letters from Aetna urging them to contact the number on the back of their Aetna ID card and offering help in locating new physicians. The letters will explain how individuals who are presently receiving care from a Providence provider can apply for transition of care coverage, which would let them to continue receiving care from the same provider for a while while being covered at the in-network benefit level, subject to Aetna approval. When a provider goes out of network, Medicare beneficiaries have ninety days to request transition of care. Find out more here.
Additionally, you can use this Aetna search engine to find a primary care physician in your neighborhood who is currently taking on new patients. When you reach the Find Care screen, input your county and ZIP code, but I suggest selecting Medford as the location. That helped me get a lot more local results. There will also be more alternatives if you are willing to see a nurse practitioner (NP) rather than a doctor (MD).
How can an Oregon Health Plan (OHP) amputee locate a physician to assist with a prosthesis?Milwaukie and Ginny
A: As with the majority of OHP coverage and services, contacting one’s coordinated care organization (CCO) is the best approach to locate necessary treatment, including care linked to amputees. For instance, Trillium Community Health Plan (877-600-5472) or Health Share of Oregon (503-416-8090) are the CCOs for OHP members in Milwaukie (Clackamas County).
Prosthetics can also be entered as a keyword in the online provider search tools for Health Share and Trillium.
OHP members can get assistance by calling OHP client services at 800-273-0557 if they are unsure of their CCO.
Please use this form to report any questions you may have for the Oregon Health Authority regarding health-related matters. The agency will make an effort to address questions that will be of interest to a wide audience, even though it cannot answer all of them. Please be aware that OHA is not qualified to offer precise medical advice regarding individual medical issues.
