COLOR BAR
SUNDAY MASTHED
SECTION FLAG
DAILY MASTHED
Monthly premium 2013/2014
Doctors and other providers in-network
Hospitals
County service areas
Health/Drug Plan Quality Rating (out of 5 stars)
Plan deductible
Hospital charges
Doctor charges, per visit
Maximum out-of-pocket
Emergency care co-pay
Drug co-pays, deductible. This year, in the gap, you'll pay 47.5% of cost of select brand name drugs & 72% of generics.
Ambulance co-pay
Routine eye exam co-pay/eyeglasses
Skilled nursing daily co-pay (no coverage after 100 days)
Supplemental routine hearing exam co-pay/hearing aids
Mental health per visit
Members
Other details
Telephone
Website
CareOregon Inc.
Advantage Star: $37.50/$34.80
4,000
Adventist, Legacy, Tuality, OHSU, Willamette Falls in metro area; others throughout service area
Clackamas, Clatsop, Multnomah, Washington, Columbia, Jackson, Josephine, Marion, Polk
$100 annual, applies to inpatient hospital only
$300/day first 5 days, then full coverage
$10 primary/$30 specialist
$6,700
$65 nationwide
Preferred generics $0;preferred brand $5; non-prefer brands 25%; $310 deductible for non-prefer brands only
$200
$20 exams; $0 for basic lenses plus up to $75 toward frames every 2 years
Days 1-20: $0; days 21-100: $100
Not covered/not covered
$30
9,300
24-hour nurseline; $0 lab tests; $0 preferred generic drugs
888-712-3258; TTY: 800-735-2900
careoregonadvantage.org
Health Net Inc.
Ruby (HMO): $23/$0Violet Option 1 (PPO): $99/$109Violet Option 2 (PPO): $0/$0Healthy Heart (PPO): $159/$199
More than 6,000
Adventist, Legacy, Tuality & PeaceHealth Southwest Medical Center in metro area; others throughout service area
HMO & PPO: Benton, Clackamas, Lane, Linn, Marion, Multnomah, Polk, Washington & Yamhill; PPO: Columbia & Clark (Wash); variations available in Douglas, Jackson & Josephine (Variations of Violet Option 2 also available in Benton, Linn, Marion, Polk & Yamhill)
Ruby: $0; Violet Option 1/2 $225/$345; Healthy Heart: $175
Ruby: $200/day first 8 days, then full cover- age. Violet Option 1: $200/day first 7 days, then full coverage. Violet Option 2: $250/day first 7 days, then full coverage. Healthy Heart: $175/day first 6 days, then full coverage
Ruby: $8 primary/$20 specialist; Violet Option 1: $12 primary & specialist; Violet Option 2 : $15; Healthy Heart: $10
Ruby: $2,500; Violet Option 1: $2,700/ $4,000 in-network/ combined; Violet Option 2: $3,400/ $4,500; Healthy Heart: $2,000/$3,500
$65 worldwide, waived if admitted
Select Care $0; Ruby: prefer generic $4; non-prefer $10; prefer brand $38; non-prefer $95; Violet Option 1/Option 2: prefer generic $5/$7; non-prefer $10/$15; prefer brand $42/$45; non-prefer $95/$95;Healthy Heart: prefer generic $5; non-prefer $8; prefer brand $35; non-prefer $95; All: discounted prefer mail order; no deductible
Ruby: $295; Violet 1/2: $295/$380; Healthy Heart: $150
Ruby, Healthy Heart, Violet Option 1: $10 exam; $250 eyewear allowance every 2 years; Violet Option 2: buy-up available
Days 1-20: all plans $0; days 21-100: Ruby $100; Violet Option 1 $100; Violet Option 2 $100; Healthy Heart $75
Not covered;Healthy Heart: $250 hearing aid allowance every 3 years.
$25
47,000
Integrated routine chiro, acupuncture, naturopathy: $15 ($20 on Violet Option 2); Silver&Fit health club membership for all but Violet 2; preventive dental for Healthy Heart; Optional extended dental/vision buy-ups. Special needs plan Jade and Aqua MA-only plan available.
800-949-6192;TTY: 800-929-9955
www.healthnet.com
Kaiser Permanente
Senior Advantage Basic (HMO): $39/$39; Senior Advantage (HMO): $99/$109
More than 4,000
Kaiser Sunnyside, Kaiser Westside Medical Center, Legacy Salmon Creek, Salem Hospital
Clackamas, Columbia, Marion, Multnomah, Polk, Washington, Yamhill, parts of Benton & Linn; Clark, Cowlitz, parts of Lewis & Wahkiakum in Washington state
$0
Basic: $275/day first 6 days, then full coverage; Senior Advantage: $200/day first 6 days, then full coverage
Basic: $30 primary/ $35 specialist; Senior Advantage: $20/$25
Basic: $4,900; Senior Advantage: $2,500
Basic: $65 worldwide; Senior Advantage: $50 worldwide
Prefer generics $5; nonprefer generics $10; prefer brand $45; nonprefer brand $90; specialty drugs 25%; gap coverage: $5/$10 for prefer/non-prefer generics; mail-order discounts; no deductible
Basic: $200; Senior Advantage: $150
Basic: $35 exams; Senior Advantage: $25; see optional package below for eyewear
Basic: days 1-10 $0; days 11-20 $25; days 21-100 $50; Senior Advantage: days 1-100 $0
Basic: $35; Senior Advantage: $25; see below for hearing aids.
Basic: $30/$15 group; Senior Advantage: $20/$10 group
40,000+
Advantage Plus: dental, extra eyewear and hearing aid optional package for $39/month; Senior Advantage: no cost for gym membership & Silver& Fit fitness program; travel benefit
866-973-1724; TTY: 711
kp.org/medicare
Moda Healthcare
Legacy Health Medicare, Powered by Moda Health: $63/$75 PPORX: $68/$82
Legacy Health: Legacy providers and other community providers; PPO RX: statewide network
Legacy Health: all Legacy hospitals; PPORX: OHSU, Providence, Salem hospital & most hospitals in Oregon
Legacy Health: Multnomah, Clackamas & Washington;PPORX: All of Oregon
Legacy Health: $0; PPORX: $150
Legacy Health: $125/day first 5 days; out-of-network: $350/day; PPORX: $295/day first 5 days; out-of-network: $400/day first 5 days
Legacy Health: $10 primary/$20 specialist; PPORX: $25/$50
Legacy Health: $2,500 in network; PPORX: $3,400
$65 worldwide, waived if admitted
Prefer generics $5; non-prefer generics $33; prefer brands: Legacy Health $40; PPORX $41; non- prefer brands 50%; specialty drugs: Legacy Health 33%; PPORX: 30%; deductibleLegacy Health: $0; PPORX $120
Legacy Health: $100; PPORX: $250
Legacy Health: $20/2 years; eyewear avail- able with Extra Care buy up; PPORX: available with Extra Care buy up
Legacy Health: days 1-20 $0; days 21-100 $50; PPORX: days 1-20 $0; days 21-100 $100
Available with Extra Care buy up
$30 ($20 for group)
9,300
Chiropractic, hearing, vision, naturopathic and acupuncture benefits available for additional premium of $10/month; 12-month travel benefit & free gym membership
888-217-2375 TTY: 711
modahealth.com
Providence Health Plans
Medicare Choice + Rx: $52/$61;Medicare Extra + Rx: $133/$137
Nearly 10,000
Providence & other hospitals, including Tuality, Tuality Forest Grove, Santiam Memorial, Salem, Silverton, Cottage Grove, Willamette Valley & PeaceHealth Southwest
Clackamas, Columbia, Lane, Marion, Multnomah, Polk, Washington, Yamhill & Clark (Wash.)
$0
Choice: $250/day first 7 days, then full coverage; out-of-network: 20%; Extra: $200/day first 7 days, then full coverage.
Choice: $20/$30 in-/out-of-network; Extra: $15
Choice: $3,000 in-network, $3,900 combined;Extra: $2,500
$65 worldwide, waived if admitted within 24 hrs
Prefer generic/preferred network pharmacy $6; prefer generic/network pharmacy $9; non-prefer generic/prefer network pharmacy $11;non-prefer generic/ network pharmacy $20; prefer brand $45;non-prefer brand $95;specialty drugs & injectable meds 33%; no deductible
Choice: $150; Extra: $100
Choice: $20 exams; $20 out-of-network, covered up to $45;Extra: $15 exams;Vision hardware: $100 every two years
Choice: days 1-20 $50, days 21-100 $100; days 1-100 20% out-of-network; Extra: days 1-20 $50; days 21-100 $100
Not covered;hearing aid discounts up to 60%
Choice: $30; 20% out-of-network;Extra: $20
43,700
Silver Sneakers free gym membership; 24-hour nurse advice line; discounts for alternative health care, acupuncture, massage, therapy, Life Line Medical Alert, Life-Balance, recreational & cultural events
503-574-5551; 800-457-6064; TTY: 711
ProvidenceHealthPlan.com
Regence BlueCross BlueShield of Oregon
MedAdvantage + Rx Classic PPO: $53/$66; MedAdvantage + Rx Enhanced PPO: $143/$178; Regence BlueAdvantage HMO: Not available/$19
PPOs: more than 10,000; HMO: more than 4,200
PPOs: 39 hospitals; HMO: 10 hospitals
Classic & Enhanced PPO: Benton, Clackamas, Clatsop, Columbia, Coos, Curry, Douglas, Hood River, Jackson, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington, Yamhill & Clark (Wash.); HMO: Clackamas, Marion, Multnomah, Polk, Washington & Clark
Classic PPO: $50; Enhanced PPO: $0; HMO: $0
Classic PPO: $400/ 1-4 day; Enhanced PPO: $300/1-6 day, then full coverage; out-of-network: contact the plan; HMO: $300/day for days 1-6, then full coverage
Classic PPO:$20 primary/$40 specialist; Enhanced PPO: $20 primary/$30 specialist; HMO: $15/$35
Classic PPO: $3,400; Enhanced PPO: $2,500;HMO: $3,400
$65 worldwide, waived if admitted within 48 hrs
Classic PPO: generics $7-$33; brands $45 or $90; specialty drugs: 27%; $205 deductible; Enhanced PPO: generics: $5-$33;brands: $45 or $90;specialty drugs: 33%; no deductibleHMO: generics: $5-$20;brands: $45-$90;specialty drugs: 27%;$200 deductible waived for generics
PPOs: $100; HMO: $200
Classic PPO: $35 exam; $50/year for eyewear; Enhanced PPO: $25 exam; $50/year for eyewear; deductible does not apply; HMO: $25 copay exam; Regence Advantages discount on eyewear
Classic PPO: $50/day, $70/day out-of-network; Enhanced PPO: $40/day, $60/day out-of-network; HMO: $50/day
Not covered; hearing aid discounts available
Classic PPO: $20-$40; Enhanced PPO: $20- $30 HMO: $35
61,000
Silver Sneakers; hearing aid discounts available for all plans; Classic & Enhanced PPO: $500 preventive dental benefit
Classic & Enhanced PPO: 800-541-8981; Non-members: 888-734-3623; HMO: 855-522-8896; Non- members: 888-734-3623; TTY: 711
www.regence.com/ medicare
UnitedHealthcare
AARP MedicareCom-plete Plan 1 (HMO): $55/$55; AARP MedicareComplete Plan 2 (HMO): $0/$0; AARP MedicareComplete Choice (PPO): $0/$0
More than 10,000
HMO Plan 1 & 2: 30 hospitals including Adventist, Legacy, Providence & Tuality; PPO: 13 hospitals including Adventist, Legacy, Tuality & Willamette Valley
HMOs: Benton, Clackamas, Lane, Linn, Marion, Multnomah, Polk, Washington; other HMO plans in Clark & Cowlitz (Wash.); PPO: Clackamas, Lane, Marion, Multnomah, Washington, Yamhill
PPO:
$0
HMO Plan 1: $250 (Days 1-7) then full coverage ($195 in Lane, Linn and Benton); HMO Plan 2: $295 (Days 1-5) then full coverage; PPO: $335 (Days 1-5), then full coverage in-network
HMO Plan 1: $10 primary/$25 specialist; HMO Plan 2: $10/$35; PPO: $10/$40 in-network
HMO Plan 1: $3,500 ($3,750 in Lane, Linn and Benton); HMO Plan 2: $4,500; PPO: $4,900
$65 worldwide, waived if admitted
HMO Plan 1/Plan 2: prefer-generic $3/$4; non-prefer generic $6/$7; prefer brand $44/$45; nonprefer brand $95; specialty drugs 33%; no deductible; PPO: prefer generic $3; nonprefer generic $6; prefer brand $45; nonprefer brand $95; specialty 33%; no deductible
$250
HMO Plan 1 & 2: $20-$35 exam; $30 standard lenses, up to $70 every hardware credit every 2 yrs; PPO: $40 exam in-network
HMO Plan 1: days 1-20 $25; days 21-40/42 $152; days 41/43-100 $0; HMO Plan 2: days 1-20 $25; days 21-47 $152; days 48-100 $0; PPO: days 1-20 $25; days 21-49 $152; days 50-100 $0
All plans: $10; hearing aids $330-$380
$40 individual in-network
46,650
Generics as low as $2 at select pharmacies; dental rider: $35; Silver Sneakers $15; HouseCalls visit $0; 24-hour nurseline; PPO passport option
800-547-5514 Current members: HMO 800-950-9355 PPO 800-643-4845
aarpmedicareplans. com
Text by BRENT HUNSBERGER Graphic by PAM MARTIN/THE OREGONIAN
Medicare managed care plans with drug coverage with the largest Medicare Advantage enrollment in the Portland region
Sources: Oregon Senior Health Insurance Benefits Assistance program; insurers; www.medicare.gov; Oregon Insurance Division.
Top Related