How Medicare Advantage networks work
Each Medicare Advantage plan contracts with its own group of doctors, hospitals, labs and pharmacies. What happens outside that network depends on the plan type:
- HMO plans generally cover only in-network care, except emergencies, urgent care and dialysis away from home. Many require a referral to see a specialist.
- PPO plans also cover out-of-network care, usually at a higher cost, but an out-of-network doctor doesn't have to agree to see you or bill the plan.
- Special needs plans for people with both Medicare and the Oregon Health Plan, or with certain chronic conditions, have networks too.
Plans renew their contracts every year. A doctor in your network this year may not be next year, so check again every fall during Open Enrollment (October 15 to December 7).
Why this matters in Oregon
For 2027, the choice of plans varies widely across the state, from 32 Medicare Advantage plans open to everyone in Multnomah County to 1 in Coos County and none in Grant, Harney, Lake, Umatilla and Union counties (CMS CY2027 Landscape). Where there are few plans, there may be few networks to choose from, and your doctor or nearest hospital may not be in any of them. Some companies also stop offering plans in some Oregon counties for 2027; if your plan is ending, see plans ending in 2027.
How to check your doctors
- List everyone you see. Include specialists, the hospital you'd use, your lab and your pharmacy.
- Search each plan's provider directory. Look up every name, for the coming plan year.
- Call the office to confirm. Ask whether they will be in that specific plan's network next year. Directories can be out of date.
- Check your drugs and pharmacy too. Each plan has its own formulary and pharmacy network.
If keeping your doctors comes first
Original Medicare has no network: any doctor or hospital in the U.S. that accepts Medicare can treat you. Many people pair it with a Medigap policy and a Part D plan, which usually means higher monthly premiums but fewer network limits. Compare the two in Original Medicare vs. Medicare Advantage in Oregon. To check which plans from the companies they work with include your doctors, you can request a call from a licensed insurance agent.
Related questions
Is Medicare Advantage available in every Oregon county?
Where there are no plans.
Can I use my plan outside Oregon?
Travel and emergencies.
How many Medicare Advantage plans are in Oregon for 2027?
County by county.
Sources
- Medicare.gov — Medicare Advantage plans
- 42 CFR 422.111 — Disclosure requirements (provider termination notices)
- 42 CFR 422.113 — Emergency and urgently needed services
- CMS — Medicare Advantage/Part D contract and enrollment data (CY2027 Landscape)
More questions in this guide
- Can I use my Medicare Advantage plan outside Oregon?
- How many Medicare Advantage plans are available in Oregon for 2027?
- Is Medicare Advantage available in every Oregon county?
Part of the guide: Medicare Part C in Oregon — Medicare Advantage · All questions
Frequently asked questions
My doctor takes Medicare. Is my doctor in every Medicare Advantage plan?
No. Accepting Medicare means accepting Original Medicare. Each Medicare Advantage plan signs its own contracts, so a doctor can be in one plan's network and not another's from the same company.
What happens if my doctor leaves my plan's network during the year?
Your plan must tell you at least 45 days ahead for a primary care or behavioral health provider, and 30 days ahead for other specialists. If a plan's network changes significantly, Medicare may allow a Special Enrollment Period.
Is emergency care covered if the hospital is out of network?
Yes. Medicare Advantage plans must cover emergency and urgently needed care anywhere in the U.S., in or out of network.
Medicare in your Oregon county
Plans, local agents and help, county by county: Multnomah · Washington · Clackamas · Lane · Marion · Jackson · Deschutes · Linn · Douglas · Yamhill · Benton · Polk · Josephine · Umatilla · Klamath · Coos · Columbia · Lincoln · Clatsop · Malheur · All 36 counties →
