Choosing Medicare Coverage When You Use Direct Primary Care: A 2027 Lane County Guide

Medicare Open Enrollment runs October 15 through December 7, 2026, for coverage that begins January 1, 2027. Medicare Advantage and Part D plans can change their premiums, drug lists (formularies), provider networks, copays, and other benefits every year, so even if you're happy with your current coverage, it's worth taking a few minutes to review what's changing for 2027. (Source: https://www.medicare.gov/health-drug-plans/open-enrollment)

For patients at Clear Health Direct Primary Care, there's one more thing to keep in mind: our physicians have opted out of Medicare.

That doesn't prevent anyone with Medicare from being a Clear Health member. It simply means your relationship with us is separate from Medicare. You sign a private contract with us and pay your DPC membership directly. Medicare specifically allows beneficiaries to contract privately with physicians who have opted out, but under that arrangement, Original Medicare, Medicare Advantage plans, and Medigap policies don't pay for the services our physicians provide. (Source: https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare)

Your Medicare coverage is still extremely important. It's what protects you when you need hospital care, specialists, surgery, imaging, cancer treatment, rehabilitation, expensive medications, or other care outside our office.

We proudly serve patients with Medicare every day.

Option 1: Original Medicare + Medigap + Part D

For many DPC patients, this is the arrangement we find easiest to work alongside.

With Original Medicare (Parts A and B), you can generally see any doctor or hospital in the country that accepts Medicare. You can then buy a Medicare Supplement (Medigap) policy to help cover the costs Original Medicare leaves to you, and choose a separate Part D prescription drug plan based on your medications and pharmacy. (Source: https://www.medicare.gov/health-drug-plans/medigap/basics?utm_source=chatgpt.com)

Medigap plans are standardized: a Plan G from one company has the same medical benefits as a Plan G from any other. That lets you compare premiums and insurers instead of trying to decipher completely different benefit structures. (Source: https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options)

Plan G is often the first Medigap option we suggest comparing because it offers fairly comprehensive supplemental coverage while keeping Original Medicare's broad provider access. That doesn't make it right for everyone; Plan N and other options may strike a better balance between premium and cost-sharing for some patients.

Prescription coverage is separate. When comparing Part D plans, don't choose on premium alone. Enter your actual prescriptions and preferred pharmacies into Medicare's Plan Compare tool, because the cheapest plan for one person's medications can be an expensive one for another's.

Be careful when switching from Medicare Advantage to Medigap

This distinction is frequently misunderstood.

The October 15–December 7 Open Enrollment Period lets you move between Medicare Advantage and Original Medicare, but it does not give everyone the right to buy any Medigap policy.

When you first become eligible, you generally get a six-month Medigap Open Enrollment Period that starts the first month you're both 65 or older and enrolled in Part B. Outside that window, insurers may use medical underwriting (meaning they can deny coverage or charge more based on your health) unless you qualify for another guaranteed-issue right. (Source: https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/buying-a-medigap-policy?utm_source=chatgpt.com)

Oregon also has a helpful Medigap "birthday rule." If you already have a Medigap policy, you can switch to another Medigap policy with the same or lesser benefits, including one from a different insurer, without health underwriting. The window starts 30 days before your birthday and ends 30 days after it. This rule only applies to people who already have Medigap; it doesn't give someone in Medicare Advantage a guaranteed way into Medigap. (Source: https://dfr.oregon.gov/laws-rules/Documents/OAR/div52-143_medicare-matrix-2023.pdf?utm_source=chatgpt.com)

If you're considering leaving Medicare Advantage, confirm that you can get a Medigap policy, and at what price, before you cancel your Medicare Advantage plan.

Option 2: A Medicare Advantage PPO

Medicare Advantage can also work alongside DPC.

Because Clear Health provides your primary care outside the insurance system, we think a PPO generally deserves particular consideration over an HMO. PPOs typically let you see out-of-network providers, although out-of-network care usually costs more and plans may still require prior authorization for some services. Oregon SHIBA describes PPOs the same way. (Source: https://shiba.oregon.gov/get-help/Pages/medicare-advantage.aspx)

For 2027, several PPOs are available in Lane County. Examples worth comparing include:

• ATRIO Choice Rx (PPO), plan ID H7006-018: $0 monthly plan premium, includes Part D drug coverage, and a $5,900 in-network out-of-pocket maximum. (Source: https://www.atriohp.com/media/254ghvxu/2027-portland-sb_final-v2.pdf)

• AARP Medicare Advantage from UHC OR-0002 (PPO): $0 monthly plan premium, includes Part D, and a $7,150 in-network out-of-pocket maximum. (Source: Medicare Advantage List)

• Regence MedAdvantage + Rx Primary (PPO): $88 monthly plan premium, includes Part D, and a $7,150 in-network out-of-pocket maximum. (Source: Medicare Advantage List)
  

With any of these plans, you still pay your Part B premium. There are other PPOs in the county, and these examples are not endorsements. The best plan depends heavily on your doctors, hospitals, prescriptions, travel needs, and expected health care use.

If you join a Medicare Advantage plan and change your mind, the Medicare Advantage Open Enrollment Period (January 1–March 31) lets you switch to a different Medicare Advantage plan or return to Original Medicare once. Keep in mind the Medigap caution above if you return to Original Medicare.

A warning about Medicare Advantage PPOs without drug coverage

Some Lane County Medicare Advantage PPOs don't include Part D. ATRIO Freedom (PPO) is one example: for 2027, it has a $0 plan premium and a $4,450 in-network out-of-pocket maximum. (Source: ATRIO Health Plans)

That lower maximum may look attractive, but there's an important catch: if you join a Medicare Advantage PPO that doesn't include drug coverage, you can't add a separate standalone Part D plan. (Source: Medicare.gov) And if you go without creditable drug coverage, you may owe a Part D late enrollment penalty if you sign up later.

A PPO without drug coverage generally makes sense only if you already have creditable prescription coverage from another source, such as VA benefits or certain retiree plans.

What to check before you enroll

Whichever option you choose, look beyond the monthly premium:

• Enter every prescription into Medicare Plan Compare.

• Confirm that your important specialists and hospitals are in the plan's network for 2027.

• Review the annual out-of-pocket maximum (for PPOs, both the in-network and the combined in- and out-of-network limits).

• Understand prior-authorization requirements.

• Consider how the plan works when you travel.

• Check the plan's Medicare star rating.

For Medicare Advantage in particular, a $0 premium doesn't mean $0 health care costs. Hospital stays, imaging, specialist visits, outpatient procedures, and other services can carry copays or coinsurance until you reach the plan's annual out-of-pocket maximum.

For Original Medicare, add up your Part B premium, Medigap premium, and Part D premium rather than comparing any one piece on its own.

We are proudly a primary care practice, the purpose of this post is to inform. If you have specific questions please ask a trusted broker or learn more at the links below.

Where to get unbiased help

Clear Health doesn't sell Medicare insurance, represent any insurance carrier, or receive commissions for plan enrollment.

For free, unbiased one-on-one help, call Oregon's Senior Health Insurance Benefits Assistance program (SHIBA) at 800-722-4134 (toll-free) or visit shiba.oregon.gov. Oregon recommends SHIBA and Medicare.gov as resources for comparing Medicare Advantage, Medigap, and Part D coverage. (Source: Oregon SHIBA)

You can also compare 2027 plans yourself at Medicare.gov/plan-compare.

Plan information in this article was reviewed October 13, 2026. Medicare Advantage networks, formularies, benefits, and availability can vary by ZIP code, so always verify your individual coverage before enrolling.