medicare managed care plans with drug coverage …media.oregonlive.com/finance/other/medicare 2013...
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SUNDAY MASTHED
SECTION FLAG
DAILY MASTHED
Monthly premium 2012/2013
Doctors and other providers in-network
Choice of 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, U.S./foreign
Drug co-pays, deductible. This year, in the gap, you'll pay 47.5% of cost of select brand name drugs & 79% of generics.
Ambulance co-pay
Routine eye exams/eyeglasses
Skilled nursing co-pay (no coverage after 100 days)
Routine hearing exams/hearing aids
Mental health per visit
Members
Other details
Telephone
Web site
CareOregon Inc.
Advantage Star $36.40/$37.50
4,000
Adventist, Legacy, Tuality, OHSU and Willamette Falls hospitals in metro area; others through-out service area
Clackamas, Clatsop, Multnomah, Washing-ton, Columbia, Jackson, Josephine, Marion and Polk
$0
$300/day first 5 days, then full coverage
$10 primary/$30 specialist
$6,700
$65 nationwide
Generic $5; brand 25%; deductible $325 for brand-name drugs only
$200
$20 exams; $0 lenses every 2 years plus up to $75 toward frames every 2 years
Days 1-20: $0; days 21-100: $100
Not covered/not covered
$30
8,400
24-hour nurse line; $0 lab tests
800-224-4840; TTY: 1-877-416-4161
careoregonadvantage.org
Health Net
Ruby HMO: $59/$23;Jade HMO SNP: NA/$0; Healthy Heart PPO: $149/$159;Violet Option 1 PPO: $99/$99; Violet Option 2 PPO: $0/$0
More than 6,500
Adventist, Legacy, Tuality and Peace-Health Southwest in metro area; others throughout service area
HMO: Clackamas, Marion, Multnomah, Polk, Washington and Yamhill. PPO: Benton, Clackamas, Columbia, Hood River, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill and Clark (Wash.); variations available in Douglas, Jackson and Josephine
Violet Plan 2:Ruby: Too new to rate
Ruby: $0; Jade: $335; Healthy Heart: $145; Violet Option 1 & 2: $225/$345
Ruby: $200/day first 8 days, then full cover- age; Jade: $250/day first 6 days, then full coverage; Healthy Heart: $175/day first 6 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
Ruby: $8 primary/$20 specialist;Jade: $0/$20; Healthy Heart: $10;Violet Option 1: $12;Violet Option 2 : $15
Ruby: $2,250; Jade: $3,000; Healthy Heart: $2,000/$3,500 in-network/combined;Violet Option 1: $2,500/$4,000;Violet Option 2: $3,400/$4,500
$65 worldwide, waived if admitted
Ruby and Jade: prefer generic $0; non-prefer generic $20; prefer brand $38; non-prefer brand $95; Healthy Heart: prefer generic $3; non-prefer generic $10; prefer brand $35; non-prefer brand $95;Violet Option 1 / Option 2: prefer generic $3/$3; non-prefer generic $15/$20; prefer brand $42/$45; non-prefer brand $95/ $95; All: discounted prefer mail order; no deductible
Ruby: $125; Jade: $175;Healthy Heart: $150;Violet 1 & 2: $175/$250
Ruby, Jade, Healthy Heart, Violet Option 1: $10 exam; $100 eye- wear allowance every 2 years; Violet Option 2: buy-up available
Days 1-20, all plans: $0; days 21-100, Ruby: $100; Jade: $100; Healthy Heart: $75; Violet Option 1: $100; Violet Option 2: $100
Hearing exam same as specialist visit; Healthy Heart: $250 hearing aid allowance every 3 years
$25
44,600
Integrated routine chiropractic, acupunc-ture, naturopathy, $15 per visit; Silver&Fit health club member-ship for all but Violet Option 2; preventive dental for Healthy Heart; Aqua MA-only plan available; optional extended dental/vision buy-ups
800-822-7698; TTY: 1-800-929-9955
www.healthnet.com
Kaiser Permanente
Senior Advantage Basic HMO: $39/$39; Senior Advantage HMO: $99/$99
More than 3,500
Kaiser Sunnyside, Providence St. Vin- cent, Salem, Peace-Health Southwest and new Westside Medical Center opening August 2013
Clackamas, Columbia, Marion, Multnomah, Polk, Washington, Yamhill, and parts of Benton and Linn; Clark, Cowlitz, and parts of Lewis and Wahkiakum in Washington
$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: $3,400; Senior Advantage: $2,500
Basic: $65 worldwide; Senior Advantage: $50
Prefer generic $6; nonprefer generic $10; prefer brand $45; nonprefer brand $65; specialty drugs 25%; vaccines $0; gap coverage: $6/$10 for prefer/non-prefer generic; mail-order discounts; no deductible
Basic: $150; Senior Advantage: $100
Basic: $35 exams; Senior Advantage: $25; see optional package below for eyewear
Basic: days 1-10, $0; days 11-100, $50; Senior Advantage: days 1-100, $0
Basic: $35 exams; Senior Advantage: $25 exams; see optional package for hearing aids
Basic: $30/$15 group; Senior Advantage: $20/$10 group
36,700
Advantage Plus: dental, extra eyewear and hearing aid optional package for $39/month; Senior Advantage: No cost for gym membership and Silver&Fit fitness program; travel benefit
855-827-5609; 877-221-8221 existing members; TTY: 711
kp.org/medicare
Providence Health Plans
Medicare Choice+Rx: $76/$52;Medicare Extra+Rx: $130/$133;Medicare Open+Rx: $155/$188
More than 9,600
Providence and many community hospitals, including Tuality, Salem, Silverton, Cottage Grove, Willamette Valley and PeaceHealth Southwest
Clackamas, Marion, Multnomah, Polk, Washington, Yamhill, Clark (Wash.); Extra & Choice also available in Columbia, Lane and Snohomish (Wash.)
Choice & Extra:
Open: Not enough info
$0
Choice: $225/day first 6 days, then full coverage; out-of-network 20%; Extra: $125/day first 6 days, then full coverage. Open: $150/day first 6 days, then full coverage; out-of-network $200/day first 6 days, then full coverage
Choice: $20/$30 in/out-of-network; Extra: $15; Open: $10/$25
Choice: $3,000;Extra and Open: $2,500
$65 worldwide, waived if admitted within 24 hours
Prefer generic/prefer pharmacy $6; prefer generic/non-prefer pharmacy $9;non-prefer generic/ prefer pharmacy $11;non-prefer generic/ non-prefer pharmacy $15; prefer brand $35; non-prefer brand $70; specialty drugs 33%; no deductible
Choice: $150;Extra and Open: $100
Choice: $20 exams; $30 out-of-network;Extra: $15 exams;Open: $10 exams; $25 out-of-network; All: Eyewear discounts
Choice: days 1-10, $0; days 11-100, $50; 20% out-of-network; Extra: days 1-20, $0; days 21-100, $50;Open: days 1-10, $0; days 11-100, $50 in- or out-of-network
Not covered/hearing aid discounts available
Choice: $20; 20% out-of-network;Extra: $15; Open: $10; $25 out-of-network
40,900
Silver Sneakers free gym membership; 24-hour nurse advice line; discounts for alternative health care, acupuncture, massage, therapy, LifeBalance, recreational and cutural events; MA-only plans available
503-574-5551; 800-457-6064; TTY: 711
ProvidenceHealthPlan.com
Regence BlueCrossBlueShield of Oregon
MedAdvantage+Rx Classic: $67/$53; MedAdvantage+Rx Enhanced: $135/$143
More than 10,000
39 hospitals in Oregon
Benton, Clackamas,Clatsop, Columbia, Coos, Curry, Douglas, Hood River, Jackson, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington, Yamhill and Clark (Wash.)
Enhanced: $0; Classic: $50
$200/day in-network and $300/day out-of-network first 7 days, then full coverage
Classic: $15 primary/ $35 specialist; Enhanced: $15/$25
Classic: $3,400; Enhanced: $2,500
$65, waived if admitted within 48 hours
Classic: generic $7.50-$33; brand $45 or $90; specialty drugs: 29%; deduct-ible $165; Enhanced: generic: $5-$33;brand: $45 or $90;specialty drugs: 33%; no deductible
$100
Classic: $35 co-pay exam; $100/year for eyewear; Enhanced: $25 co-pay $200/year for eyewear; deductible does not apply
In-network: days 1-20, $40/day; days 21-100, $80/day ($0/day for Enhanced); Out-of-network: days 1-20, $60/day; days 21-100, $100/day ($0/day for Enhanced)
Classic: $15-$35 exams; out-of-network $35; Enhanced: $15-$25; out-of-network $25; Hearing-aid discount
Classic: $15-$35; Enhanced: $15-$25
49,400
$500 preventive dental benefit;SilverSneakers/Health/WellnessEducation
800-541-8981; 888-734-3623 nonmembers; TTY: 711
regence.com/medicare
ODS Health Plan Inc.
Advantage PPO+Rx NA/ $68; Advantage PPO+Rx Select: $128.30/$139
More than 6,500
OHSU, St. Charles, Providence system, Legacy and most major independents; outside the network, any hospital that accepts Medicare
All of Oregon
$150; Select: $50
In-network: $295/day first 5 days, then full coverage; Select: $250/day first 5 days, then full coverage. Out-of-network: $400/day first 5 days, then full coverage; Select: $350/day first 5 days, then full coverage
$25 primary/$50 specialist; Select: $20/$35
$3,400
$65 worldwide, waived if admitted
Both plans: prefer generic $5; non- prefer generic $33; prefer brand $41; non-prefer brand 50%; specialty drugs 30%; deductible $120
$250; Select: $100
Not covered; Select: $35 every 2 years; eyewear available with Extra Care buy-up
Days 1-20, $0; days 21-100, $100; Select: days 1-10, $0; days 11-100, $50
Available with Extra Care buy-up
$30/$20 for group
7,800
12-month travel/visitor benefit; chiropractic, hearing, vision, naturopathic and acupuncture benefits available for additional premium; MA-only plan available
888-217-2375 TTY: 711
odscompanies.com/odsadvantage
UnitedHealthcare
AARP MedicareCom-plete Plan 1 HMO: $65/$55; AARP MedicareCom-plete Plan 2 HMO: NA/$0; AARP MedicareCom-plete Choice PPO: $0/$0
More than 7,500
HMO Plan 1 & 2: 30 hospitals in-network including Adventist, Legacy, Providence and Tuality; PPO: 13 hospitals in-network including Adventist, Legacy, Tuality and Willamette Valley
PPO: Clackamas, Lane, Marion, Multnomah, Washington and Yamhill; HMOs: Clackamas, Marion, Multnomah, Polk and Washington; other plans available in Benton, Linn and Lane, as well as Clark and Cowlitz in Washington
HMO Plans 1 & 2:
PPO:
$0
HMO Plan 1: $250/day first 7 days, then full coverage; HMO Plan 2: $265/day first 6 days, then full coverage; PPO: $295/day first 5 days, then full coverage
HMO Plan 1: $10; HMO Plan 2: $15; PPO: $15
HMO Plan 1: $3,500; HMO Plan 2: $3,900; PPO: $4,500 in-network
All Plans: $65 worldwide
HMO Plan 1 & Plan 2: prefer generic $3/$4; non-prefer generic $6/$7; prefer brand $44/$45; nonprefer brand $88/$95; specialty drugs 33%/ 33%; no deductible PPO: prefer generic $3; nonprefer generic $6; prefer brand $45; nonprefer brand $95; specialty 33%; no deductible
$200
HMO Plan 1 & 2: $0-$20 exam; $30 co-pay eyewear (up to $70 every 2 years); PPO: $0-$30 in-network/$45 out-of-network exam
HMO Plan 1: days 1-20, $50; days 21-54, $75; days 55-100, $0; HMO Plan 2: days 1-20, $50; days 21-40, $150; days 41-100, $0; PPO: days 1-20, $50; days 21-40, $150; days 41-100, $0
HMO Plan 1/Plan 2/PPO: $20/$15/$30 in-network; hearing aids $340-$390
$40 individual in-network
34,850
Generics as low as $2 at select pharmacies; dental riders: $15/$29
800-547-5514
aarpmedicareplans.com
PAM MARTIN/THE OREGONIAN
Medicare managed care plans with drug coverage offered by seven insurers with the largest Medicare Advantage enrollment in Oregon
Sources: Oregon Senior Health Insurance Benefits Assistance program; insurers; www.medicare.gov; Oregon Insurance Division.