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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.