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MEDICARE GUIDE

Largest Portland-area Medicare managed care plans with drug coverage

THE OREGONIAN ?

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Monthly premium 2018/2019

Aetna

Health Net

Portland area: Aetna Medicare Choice PPO: NA/$17; Aetna Medicare Select PPO: NA/$47

Ruby (HMO): $0/$0 in Portland area; Violet 1 (PPO): $116/$120 in Portland area; Violet 2 (PPO): $19/$19 in Portland area; $0/$0 in Clark County (Wash.)

Humana

Gold Plus HMO: $0/$0 in Portland area; $69/$69 in Deschutes and Jefferson counties

Kaiser Permanente

Senior Advantage Basic (HMO): $44/$44; Senior Advantage (HMO): $127/$127

Moda Health Plan

Moda Health PPORX: $119/$132; PPORX Enhanced: NA/$195

PacificSource

MyCare Rx 40 (HMO): $23/$0; MyCare Rx 39 (HMO): $76/$68

Providence Health Assurance

Prime + RX (HMO): $0/$0; Choice + RX (HMO-POS): $88/$88; Extra + RX (HMO): $165/$173

Regence BlueCross BlueShield of Oregon

BlueAdvantage HMO: $0/$0; BlueAdvantage HMO Plus: $27/$35; MedAdvantage + Rx Primary PPO: NA/$19; MedAdvantage + Rx Classic PPO: $42/$48 or $93/$76. Call for details

United Healthcare (AARP)

AARP MedicareComplete Plan 1 (HMO): $73/$74 ($53/$55 in Benton, Lane, Linn counties); AARP MedicareComplete Plan 2 (HMO): $0/$0; AARP MedicareComplete Choice (PPO): $33/$35

Providers

9,000+

in network(s)

7,000+

3,084 in Portland area; 613 in Deschutes, Jefferson counties

3,000+

10,000+ statewide

4,400+

Prime: 3,900+; All other plans: 16,000+

HMO: 5,500+; PPO: 8,500+

HMO: 3,900+ (1,300+ in Benton, etc.); PPO: 4,700+

Hospitals

Legacy

Legacy, Adventist, PeaceHealth in Portland area and Clark County; others throughout service area

Adventist, Tuality, Legacy, OHSU in Portland area; St. Charles in Deschutes and Jefferson counties

Kaiser Sunnyside, Kaiser Westside, Legacy Salmon Creek, Salem Hospital

OHSU, Providence, Legacy, Adventist, Tuality, Salem Health and most others in Oregon

All Legacy hospitals

Providence, Tuality, Salem, Silverton, Willamette Valley, PeaceHealth SW Medical Center and others

HMO: 25 hospitals; PPO: 44 hospitals

HMOs: 26 hospitals including Adventist, Legacy, OHSU, Providence and Tuality; PPO: Adventist, Legacy, OHSU, Providence and Tuality

County service areas

Clackamas, Multnomah, Washington, Yamhill

HMO and PPO: Benton, Clackamas, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Yamhill, Washington HMO only: Coos, Crook, Deschutes, Jefferson. PPO only: Clark (Wash.)

Multnomah, Washington, Clackamas, Deschutes and Jefferson

In Oregon: Clackamas, Columbia, Marion, Multnomah, Polk, Washington, Yamhill, parts of Benton and Linn; In Washington: Clark, Cowlitz, parts of Wahkiakum

PPORX: All 36 Oregon counties; PPORX Enhanced: Clackamas, Clatsop, Jackson, Josephine, Lincoln, Multnomah, Tillamook, Washington

Clackamas, Multnomah, Washington

Prime: Clackamas, Multnomah, Washington. Choice/Extra: Clackamas, Columbia, Lane, Marion, Multnomah, Polk, Washington, Yamhill and Clark (Wash.)

HMOs: Clackamas, Multnomah, Washington, Clark (Wash.); PPO: Portland area, Benton, Columbia, Coos, Curry, Douglas, Jackson, Josephine, Lane, Linn, Marion, Polk, Yamhill, Clark

HMOs: Benton, Clackamas, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill; PPO: Clackamas, Lane, Marion, Multnomah, Washington, Yamhill

MEDICARE GUIDE Largest Portland-area Medicare managed care plans with drug coverage

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Aetna

Health Net

Health/drug plan quality rating (out of 5 stars)

Humana

Kaiser Permanente

Moda Health Plan

PacificSource

Providence Health Assurance

2019 ratings had not been released by deadline. Check online at for updates.

Regence BlueCross BlueShield of Oregon

United Healthcare (AARP)

Plan

Both plans: $0 Ruby $0; Violet $0

$0

Both plans: $0

Both plans: $0 Prime: $100;

All plans: $0

All plans: $0

deductible

1: $185; Violet

Choice &

per year

2: $200

Extra: $0

Hospital charges

per day, in-network (unless otherwise noted)

Choice PPO: $375 days 1-4, then $0; Select PPO: $325 days 1-5; then $0

Ruby: $465 days 1-4, then $0; PPO in-network: Violet 1: $225 days 1-7, then $0; Violet 2: $375 days 1-4, then $0

$400 days 1-4, then $0 in Portland area; $395 days 1-4, then $0 in Deschutes and Jefferson counties

Basic: $265 days 1-6, then $0; Senior Advantage: $200 days 1-6, then $0

PPORX: $295 days 1-5, then $0; $450 days 1-5, then $0 out-of-network; Enhanced: $150 days 1-5, then $0; $300 days 1-5, then $0 out-of-network

MyCare Rx 40: $370 days 1-5, then $0

MyCare Rx 39: $295 days 1-5, then $0

Prime: days 1-4 $450, then $0. Choice: days 1-6 $300, then $0; Extra: days 1-5 $250, then $0

HMO: $430 days 1-4; HMO Plus: $375 days 1-4; Primary PPO: $400 days 1-4; Classic PPO: $395 days 1-4. Call for details.

HMO 1: $285 days 1-7 ($195 Benton, Lane, Linn counties); HMO 2: $430 days 1-4 ($425 Benton, Lane, Linn); PPO: $350 days 1-5 in-network ($430 days 1-24 out)

Doctor charges

per visit, in-network; primary/ specialist

Choice PPO: $0/$40; Aetna Medicare Select PPO: $0/$30

Ruby: $0/$45; Violet 1: $12/ $25; Violet 2: $15/$30 or $15/$35

$0/$40

Basic: $25/$35; Senior Advantage: $15/$25

PPORX: $25/$35; PPORX Enhanced: $0/$20

MyCare Rx 40: $0/$35 MyCare Rx 39: $0/$25

Prime: $0/$40; Choice: $15/$30; Extra: $10/$20

HMO: $5/$40; HMO Plus: $0/$35; Primary PPO: $15/$45; Classic PPO: $10/$40

HMO 1: $0/$25 ($0/$30; Benton, Lane, Linn counties); HMO 2: $5/$40; PPO: $0/$30 in-network ($25/$50 out)

Maximum out-ofpocket per year; in-network/inand out-of network combined

Choice PPO: $4,900/ $10,000; Select PPO: $5,200/ $10,000

Ruby: $3,900; Violet 1: $2,900/ $4,000; Violet 2: $5,550/ $6,600 or $6,700/ $8,700

$5,700 in-network in Portland area, $5,500 in Deschutes and Jefferson counties

Basic: $4,900; Senior Advantage: $2,500

PPORX: $3,900; PPORX Enhanced: $2,500

Both plans: $4,950

Prime: $5,500; Choice: $4,500/$6,700; Extra: $3,400

HMO: $5,500; HMO Plus $4,900; Primary PPO: $6,700/ $10,000; Classic PPO: $6,000/ $10,000. Call for details.

HMO 1: $3,500 ($2,900 Benton, Lane, Linn counties); HMO 2: $5,900 ($4,100 Benton, Lane, Linn); PPO: $4,900/ $10,000

Emergency care co-pay

Both plans: $90, worldwide, waived if admitted

Ruby & Violet 2: $90: Violet 1 & Aqua: $120; $0 worldwide

$90, waived if admitted within 24 hrs.

Both plans: $75 worldwide, waived if admitted

Both plans: $65 worldwide, waived if admitted in 24 hrs.

Both plans: $90 worldwide, waived if admitted with in 72 hrs.

All plans: $90 worldwide, waived if admitted within 24 hrs.

All plans: $90 worldwide, waived if admitted within 48 hrs.

$90 worldwide, waived if admitted within 24 hrs.

MEDICARE GUIDE Largest Portland-area Medicare managed care plans with drug coverage

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Drug deductible

Aetna

Health Net

Tiers 4-5 only: Choice PPO: $145 Select PPO: $95

Tiers 3-5 only: $95 to $150

Humana

Tiers 3-5 only: $150 in Portland, $100 elsewhere

Kaiser Permanente

$0

Moda Health Plan

Both plans: $120

PacificSource

Tiers 3-5 only: MyCare Rx 40: $200; MyCare Rx 39: $150

Providence Health Assurance

Tiers 3-5 only: Prime: $270; Choice: $240; Extra: $0

Regence BlueCross BlueShield of Oregon

United Healthcare (AARP)

HMO Plus: $0 all tiers. Tiers 3-5 only: HMO $200; Primary: $300; Classic: $250

Tiers 3-5 only: All plans: $200275

Drug co-pays for

Tier 1: preferred generics

Tier 2: non-prefered generics

Tier 3: preferred brand

Tier 4: non-preferred brand

Tier 5: specialty

Tier 6: select care drugs

Gap coverage: This year, you'll pay 25% of the cost of select brand-name drugs and 37% of generics

Both plans: gap coverage

Tiers 1 and 2 preferred/ non-preferred.

Tier 1: $0/$15 Tier 2: $10/$20 Tier 3: $47 Tier 4: $100 Tier 5: 30% (Choice); 31% (Select)

Mail-order discounts available

Portland area, preferred network.

Ruby: Tier 1: $3 Tier 2: $8 Tier 3: $37 Tier 4: $90 Tier 5: 30% Tier 6: $0; Violet 1: Tier 1: $5 Tier 2: $10 Tier 3: $37 Tier 4: $90 Tier 5: 31% Tier 6: $0 Violet 2: Tier 1: $5 Tier 2: $15 Tier 3: $37 Tier 4: $90 Tier 5: 30% Tier 6: $0

Preferred pharmacy network.

In Portland area Tier 1: $2 Tier 2: $8 Tier 3: $47 Tier 4: $100 Tier 5: 30%

In Deschutes and Jefferson counties Tier 1: $4 Tier 2: $15 Tier 3: $47 Tier 4: $100 Tier 5: 31%

Tier 1: $5 Tier 2: $10 Tier 3: $45 Tier 4: $90 Tier 5: 33% Tier 6: $0 injectable Part D vaccines

Gap coverage: Tiers 1 and 2: $5/$10 Tiers 3-5: 25% Tier 6: $0 Mail-order dis-

counts available

Both plans: Tier 1: $2 Tier 2: $20 Tier 3: $45 Tier 4: $100 Tier 5: 30%

MyCare Rx 40: Tier 1: $3 Tier 2: $12 Tier 3: $37 Tier 4: 31% Tier 5: 29% Tier 6: $0

MyCare Rx 39: Tier 1: $2 Tier 2: $12 Tier 3: $37 Tier 4: 31% Tier 5: 30% Tier 6: $0

Both plans: Coverage through gap for Tier 3 (partial gap coverage) and Tier 6 (full gap coverage)

Prime: Tier 1: $0 Tier 2: $10 Tier 3: $47 Tier 4: $100 Tier 5: 27% Choice: Tier 1: $4 Tier 2: $13 Tier 3: $47 Tier 4: $100 Tier 5: 28% Extra: Tier 1: $4 Tier 2: $12 Tier 3: $47 Tier 4: $90 Tier 5: 33%

Preferred pharmacy network; mail order.

HMO: Tier 1: $3 Tier 2: $12 Tier 3: $40 Tier 4: 40% Tier 5: 29% HMO Plus: Tier 1: $3 Tier 2: $8 Tier 3: $40 Tier 4: 40% Tier 5: 33% PPOs: Tier 1: $3 Tier 2: $13 Tier 3: $40 Tier 4: 40% Tier 5 Primary PPO: 27% Tier 5 Classic PPO: 28%

HMO plans: Tier 1: $4/($3, Benton, Lane, Linn counties) Tier 2: $12 Tier 3: $47 Tier 4: $100 Tier 5: 27%29% PPO plan: Tier 1: $3 Tier 2: $10 Tier 3: $45 Tier 4: $95 Tier 5: 29%

Outpatient surgery (ASC = ambulatory surgical center)

Choice PPO: $325 Select PPO: $225

Based on place of service (ASC or hospital). Call for details

$200 ASC in-network

Basic: $210; Senior Advantage: $125

PPORX: $295; PPORX Enhanced: $100

Both plans: $225

Prime: $450 Choice: $250 Extra: $150

HMO Plus: 20%, ASC $275; HMO and PPOs: 20%, ASC 15%

Varies by plan: $175-$430 (PPO in-network)

Chemotherapy cost-share

All plans: 20%

Ruby: 20%; Violet 1: 17% in-network; Violet 2: 18% or 19% in-network

20% in-network

Basic: 0-15%; Senior Advantage: 0-15%

All plans: 20% in-network; 30% out-ofnetwork

Both plans: 20% All plans: 20%

All plans: 20%

All plans: 20% in-network; PPO: 30% outof-network

MEDICARE GUIDE Largest Portland-area Medicare managed care plans with drug coverage

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Durable equip.

(wheelchairs, oxygen, etc.)

Aetna All plans: 20%

Health Net

Humana

Ruby: 20%; Violet 1: 17% in-network; Violet 2: 18% or 19% in-network

20% in-network

Kaiser Permanente

0%-20%

Moda Health Plan

PacificSource

Providence Health Assurance

All plans: 20% in-network; 30% outof-network

Both plans: 20%

All plans: 20%

Regence BlueCross BlueShield of Oregon

All plans: 20%

United Healthcare (AARP)

All plans: 20% in-network; PPO: 50% outof-network

Skilled nursing co-pay per day

(no coverage after 100 days)

All plans: days 1-20: $0, days 21-100: $172

All plans: days 1-20: $0; days 21-100: $170 in-network; PPO: $220 out-of-network

In-network: days 1-20: $0, days 21-55: $172, days 56-100: $0

Basic: days 1-20: $0, days 21-100: $50; Senior Advantage: days 1-100: $0

Both plans: days 1-20: $0, days 21-100: $150

Both plans: days 1-20: $0, days 21-100: $172

Prime: days 1-20: $0, 21-100: $172; Choice: days 1-20: $0, 21-100: $160; Extra: days 1-20: $0, 21-100: $150

HMOs: days 1-20: $0, days 21-100: $167; PPOs: days 1-20: $0, days 21-100: $160 (Classic) or $167 (Primary)

Day limits vary by plan. Days 1-20: $0, days 21-39(-57): $160, days 40(-58)100: $0. Call for details.

Routine eye exams, eyewear

Choice PPO: $0 annual exam, $100 annual hardware allowance; Select PPO: $0 annual exam, $150 annual hardware allowance

Ruby, Violet 1: $10 annual exam, $250 eyewear allowance every 24 months; Violet 2: Buy-up available

$0 routine exam per year; $300 allowance for contacts or eyeglasses in Portland, $100 in Deschutes and Jefferson

Basic: $35 exams; Senior Advantage: $25. See optional package in "Other Details" for eyewear

Both plans: $0 co-pay exam, $0 co-pay vision hardware every 2 years

MyCare Rx 40: $20 eye exam, $200 eyewear allowance every 2 years; MyCare Rx 39: $25 eye exam, $200 eyewear allowance every 2 years

Prime: $30 annual exam allowance, $75 eyewear allowance every 2 years; Choice & Extra: $60 annual exam allowance, $250 eyewear allowance every year

HMO Plus: $0 exam, $100 eyewear allowance; Classic PPO: $0 exam, $100 eyewear allowance; HMO and Primary PPO: Optional package in "Other Details"

HMO plans: $20 annual exam, $0 eyewear copay, up to $70 credit for frames (standard lenses included) or $105 credit for contacts every 2 years; PPO: $20 exam in-network

Supplemental routine hearing exam co-pay/ hearing aids

All plans: $0 exam per year; $1,000 hearing aid allowance per year

Included for Ruby (HMO) members. $0 exam, $0-$1,580 per aid

$0 exam, up to 3 fittings per year, $499 or $799 per ear per year

Basic: $35 exams; Senior Advantage: $25. See optional package in "Other Details" for hearing aids

Both plans: $45 exams, $699-$999 co-pay per aid

Both plans: $45 annual exam, $699/$999 co-pay per aid

All plans: $45 exam, $699$999 per aid

All plans: available through optional package in "Other Details"

HMO 1 & PPO (in-network): $0; HMO 2: $5 exam. Hearing aids, all plans: $330-$380, 2 per year

Mental health per visit, individual/group

All plans: $40 copay

Ruby: $35-$40; PPO (in-network) Violet 1 $25; Violet 2 $30-$35

$40-$55

Basic: $25/$12; Senior Advantage: $15/$7

PPORX: $25 in-network, $40 out; Enhanced: $20 in, $40 out

MyCare Rx 40: $35 MyCare Rx 39: $15

Prime: $40 Choice: $30 Extra: $20

HMO: $5-$40; HMO Plus: $0-$35; Primary PPO: $40; Classic PPO: $40

All plans: $40/$30 in-network; PPO: $45/$35 out-of-network

Members

New in 2019

75,000+

6,000

60,000+

18,000

14,000+

57,300+

50,000+

45,000+

MEDICARE GUIDE Largest Portland-area Medicare managed care plans with drug coverage

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Other details

Aetna

Health Net

SilverSneakers fitness benefit; $0 in-network PCP visits and lab services; embedded dental allowance; no referrals for in- or out-of- network services; Resources For Living referral service. Call for details.

Silver&Fit program, Worldwide Emergency, Telehealth included on all plans; routine chiropractic, acupuncture, naturopathy included on some plans; dental/vision buy-ups available. Call for details.

Humana

Kaiser Permanente

Moda Health Plan

PacificSource

Providence Health Assurance

Regence BlueCross BlueShield of Oregon

United Healthcare (AARP)

$0 Tier 1&2 90-day preferred mail order Rx, Tier 1 ED drugs, SilverSneakers, acupuncture, over-the-counter allowance, 24-hour nurse hotline, post-hospital discharge meal benefit, $0 phone/video doctor and mental health consults

Advantage Plus: Dental, eyewear and hearing aid optional package for additional $44/month;

Senior Advantage: No cost for gym membership and Silver&Fit fitness program; outside service area benefit

All plans include $500 dental benefit for comprehensive, preventive care. Chiropractic, naturopathic and acupuncture benefits available for extra $6/month; 12-month travel benefit; free gym membership and home fitness kits through Silver&Fit

Acupuncture, chiropractic, and naturopathy benefits; $0 gym membership; $0 colonoscopies; $0 bone density exams (DEXA); $0 chronic-care and transition-care management; mail-order prescription discount

Rx deductible waived on generic tiers; Silver&Fit free gym membership; $0 online video visits with Providence Express Care Virtual; optional dental plans start at $33.70/ month; 24-hour nurse line

Silver&Fit on all plans; HMO and Primary PPO optional benefits: $20/month (preventive dental, vision and hearing); HMO Plus and Classic PPO optional benefits: $28/ month (comprehensive dental and hearing). *PPO cost shares are for in-network.

$0 Tier 1 90-day preferred mail order Rx; chiropractic/ acupuncture benefit (Plan 1 and PPO); dental riders: $34-$39; Renew Active Fitness $0 (all plans); Solutions for Caregivers $0; HouseCalls visit $0; 24-hour nurse line; PPO Passport option. Call for details.

Telephone

833-859-6031 TTY: 711

800-949-6192 TTY: 711

800-833-2364 TTY: 711

877-390-1502 TTY: 711

888-217-2375 TTY: 711

855-265-5969 TTY: 711

800-457-6064 TTY: 711

844-734-3623 TTY: 711

800-UHC-6509 TTY 711

Website



or.healthnet

medicare

medicare modahealth. com/medicare

medicare. pacificsource. com

providence health

medicare

uhcmedicare health

Other Medicare Advantage plan providers

Humana Type of plan Local HMO & PPO

Within Portland area

Community Health Plan of Washington

Local HMO

Counties served

Benton, Clackamas, Columbia, Crook, Deschutes, Hood River, Jefferson, Lincoln, Linn, Malheur, Multnomah, Polk, Washington

Clark (Wash.)

Phone

888-204-4062 TTY: 711

800-944-1247

Website

humana-

healthfirst.

ATRIO Health Plans Local PPO

Outside Portland area

AllCare Advantage Local HMO

Samaritan Advantage Health Plan

Local HMO

Douglas, Jackson, Josephine, Douglas, Jackson, Josephine Klamath, Marion, Polk

Benton, Lincoln, Linn

877-672-8620 TTY: 800-735-2900



888-460-0185 TTY: 800-735-2900



800-832-4580 TTY: 800-735-2900

medicare.

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