Breaking News: Samaritan’s Medicare Advantage Exit
Samaritan Health Plans, the insurance division of Corvallis, Oregon-based Samaritan Health Services, has announced its decision to exit the Medicare Advantage market in 2026. This significant development was first reported by the Lincoln Chronicle on September 3rd, marking a major shift in Oregon’s healthcare insurance landscape.
The announcement affects thousands of Medicare beneficiaries across Oregon’s mid-Willamette Valley and central coast regions. Bruce Butler, CEO of Samaritan Health Plans, confirmed the decision while emphasizing the organization’s commitment to communicating detailed information about 2026 plan options in October, following Centers for Medicare & Medicaid Services (CMS) regulatory requirements.
Immediate Reassurance for Current Members
Despite the upcoming market exit, Butler stressed that no changes will occur for current health plan members in 2025. This provides a crucial transition period for affected beneficiaries to explore alternative Medicare Advantage options or consider returning to Original Medicare with supplemental coverage.
Impact on Current Medicare Members
The decision directly affects nearly 14,000 Medicare Advantage members enrolled in Samaritan’s Health Maintenance Organization (HMO) and Dual Special Needs Plans (D-SNP) across three Oregon counties:
- Lincoln County
- Benton County
- Linn County
Understanding D-SNP and HMO Plans
Samaritan’s D-SNP plans specifically serve dual-eligible beneficiaries who qualify for both Medicare and Medicaid benefits. These specialized plans coordinate care between both programs, often providing additional benefits like transportation, meal delivery, and comprehensive care management.
The HMO plans offer managed care through Samaritan’s provider network, typically featuring lower out-of-pocket costs in exchange for using network providers and obtaining referrals for specialist care.
Reasons Behind the Market Exit
Butler’s statement revealed that “Samaritan Health Plans has not been immune to nationwide challenges in healthcare.” These challenges reflect broader trends affecting Medicare Advantage insurers across the United States.
Industry-Wide Pressures
Several factors contribute to the challenging Medicare Advantage environment:
- Rising medical costs outpacing Medicare payment updates
- Increased regulatory scrutiny from CMS
- Star rating pressures affecting bonus payments
- Administrative burden of compliance requirements
- Risk adjustment changes impacting reimbursement rates
Sustainability Concerns
As part of an integrated health system serving Oregon’s mid-Willamette Valley and central Oregon coast, Samaritan is “evaluating multiple options to ensure sustainability for the long term.” This strategic review indicates the organization’s commitment to maintaining its core healthcare services while adjusting its insurance portfolio.
What This Means for Oregon Healthcare
Samaritan’s exit reduces Medicare Advantage competition in affected Oregon counties, potentially limiting choices for beneficiaries. However, other national and regional insurers continue serving these markets.
Regional Healthcare Impact
The mid-Willamette Valley and central Oregon coast rely heavily on Samaritan Health Services for healthcare delivery. The organization operates multiple hospitals and clinics throughout the region, and its continued focus on direct care provision remains unchanged.
Provider Network Considerations
Current Samaritan Medicare Advantage members who wish to continue receiving care from Samaritan providers should verify network participation with alternative Medicare Advantage plans or consider Original Medicare, which typically provides broader provider access.
Alternative Medicare Options for Affected Members
Displaced Samaritan Medicare Advantage members have several alternatives:
Other Medicare Advantage Plans
Multiple insurers offer Medicare Advantage plans in Oregon, including:
- Kaiser Permanente Northwest
- Providence Health Plan
- Moda Health
- PacificSource
Original Medicare Plus Supplements
Beneficiaries can return to Original Medicare (Parts A and B) combined with:
- Medigap supplemental insurance
- Stand-alone Part D prescription drug plans
Medicare Special Enrollment Periods
Plan terminations trigger Special Enrollment Periods, allowing affected members to enroll in new coverage outside the typical Annual Open Enrollment Period.
Timeline and Next Steps
2025: Status Quo
Current Samaritan Medicare Advantage members will experience no changes throughout 2025, providing stability during the transition period.
October 2024: Plan Information
Following CMS regulations, Samaritan will provide detailed information about 2026 plan options in October, coinciding with the Annual Open Enrollment Period (October 15 – December 7, 2024).
2026: Market Exit
Samaritan will officially discontinue its Medicare Advantage plans effective January 1, 2026.
Company’s Other Insurance Offerings
Despite exiting Medicare Advantage, Samaritan Health Plans continues offering:
Managed Medicaid Plans
Serving Oregon’s Medicaid population through contracted arrangements with the state’s Coordinated Care Organizations (CCOs).
Commercial Employer Plans
Providing group health insurance to businesses throughout the region, supporting local employers and their workforce.
Integrated Care Model
The insurance division works closely with Samaritan Health Services’ provider network, maintaining an integrated approach to healthcare delivery and financing.
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