Clatsop County is losing its only Medicare Advantage plan starting next year after Moda Health decided to pull out. But Medicare recipients changing coverage by early December will have access to a newer, hybrid medical savings account.

As of September, more than 9,100 people in the county were covered by traditional Medicare, the federal health insurance program for the elderly covering basic hospital and medical services. Nearly 1,200 people were covered by Moda Health’s Medicare Advantage plan, which bundles hospital and medical coverage with other specialty services such as dental, vision and hearing.

Medicare enrollment site

The open enrollment period for Medicare started earlier this month and runs until Dec. 7.

Jonathan Nicholas, a spokesman for Moda, said in an email that the insurer couldn’t continue providing a Medicare Advantage plan with reasonable coverage at a reasonable cost.

“We also, I should say, felt bound to consider our responsibility to Moda members throughout the rest of the state,” Nicholas said. “Had we continued to offer plans at a loss in Clatsop County, other members across Oregon would have faced increased premiums to offset those losses.”

Moda’s departure comes two years after FamilyCare Health pulled its Medicare Advantage plan out of Northwest Oregon, leaving 600 people in the county to find new coverage. The county had seven Medicare Advantage providers as recently as 2009.

Medicare Advantage plans have been leaving rural areas over the years because of several factors. The scarcity of rural providers make such markets less appealing to insurers providing Medicare Advantage plans that bundle services. Medicare recipients can get care from any provider, but Medicare Advantage plans usually require patients to find providers in the plan’s network.

Meanwhile, the Congressional Budget Office has found that Medicare Advantage plans underpay traditional Medicare by 3% and negotiate even lower reimbursement rates with rural hospitals, where it is more difficult for people to stay in network coverage.

Hospital executives in Eastern Oregon, another area with scarce Medicare Advantage options, recently partnered with Moda to create Summit Health, a new Medicare Advantage plan spanning 12 counties.

“We created Summit Health following our success with the Eastern Oregon Coordinated Care Organization,” Nicholas said. “… Its owners include regional providers who have for decades been focused on meeting the health care needs of their communities. All of us at Moda like to think that Summit Health could indeed be a model to bring more care options to the coast.”

The open enrollment period for Medicare began earlier this month and runs until Dec. 7. The two options left in the county are a traditional Medicare supplemented by a wide array of Medigap policies for speciality services like prescription drugs, and a new Medicare medical savings account being offered by Lasso Healthcare.

The Centers for Medicare & Medicaid Services considers the savings accounts a type of Medicare Advantage plan. Recipients deposit money into their medical savings account, using or banking it from year to year for health care costs. If they surpass a high yearly deductible, a Medicare Advantage plan kicks in to cover the rest.

“We (haven’t) had an MSA plan in Oregon for like 10 years or more,” said Lisa Emerson, a program manager with the volunteer group Senior Health Insurance Benefits Assistance. “So Lasso filling this plan type in Oregon is a new thing.”