2013 / 2014 Medicare Advantage Plan Information Click here to jump to the Chart Legend | ||||||||||||
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Plan Name | Monthly Premium |
Part A&B Maximum Out-Of |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Formulary Drugs | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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2013 AARP MedicareComplete Choice (PPO) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H3812 -001 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete Choice (PPO) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $7.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 AARP MedicareComplete Plan 2 (HMO) | $0.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H3805 -012 -0 | $4.00 | $7.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete Plan 2 (HMO) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H7006 -006 -0 | |||||||||||
2014 ATRIO Bronze (Willamette) (PPO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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2013 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H6815 -002 -0 | $0.00 | $20.00 | $38.00 | $38.00 | 4,263 2013 Formulary | ||
-- | -- | |||||||||||
2014 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $38.00 | $38.00 | 4,187 2014 Formulary | |||
2013 Health Net Ruby (HMO) | $23.00 | $2,250 | $0 | No additional gap coverage, only the Donut Hole Discount | H6815 -001 -0 | $0.00 | $20.00 | $38.00 | $38.00 | 4,263 2013 Formulary | ||
-- | -- | |||||||||||
2014 Health Net Ruby (HMO) | $0.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $38.00 | $38.00 | 4,195 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H7006 -005 -0 | |||||||||||
2014 ATRIO Bronze Rx (Willamette) (PPO) | $17.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $45.00 | $45.00 | 3,267 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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-- This plan not offered in 2013 -- |
H5520 -012 -3 | |||||||||||
2014 Health Net Violet Option 2 (PPO) | $19.00 | $6,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $15.00 | $45.00 | $45.00 | 4,195 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H6237 -002 -0 | |||||||||||
new | new | new | ||||||||||
2014 Regence BlueAdvantage HMO (HMO) | $19.00 | $3,400 | $200 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $45.00 | $45.00 | 3,414 2014 Formulary | |||
2013 Providence Medicare Choice (HMO-POS) | $20.00 | $3,000 | No Rx Coverage | H9047 -035 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Providence Medicare Choice (HMO-POS) | $28.00 | $3,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 ATRIO Special Needs Plan (Willamette) (HMO SNP) | $37.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5995 -001 -0 | 25% | 3,285 2013 Formulary | |||||
2014 ATRIO Special Needs Plan (Willamette) (HMO SNP) | $34.80 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 3,192 2014 Formulary | ||||||
2013 CareOregon Advantage Plus (HMO-POS SNP) | $37.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5859 -001 -0 | 25% | 25% | 2,727 2013 Formulary | ||||
2014 CareOregon Advantage Plus (HMO-POS SNP) | $34.80 | n/a | $310 | Some Generics | $0.00 | 25% | 25% | 2,801 2014 Formulary | ||||
2013 CareOregon Advantage Star (HMO-POS) | $37.50 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H5859 -003 -0 | $5.00 | 25% | 2,727 2013 Formulary | ||||
2014 CareOregon Advantage Star (HMO-POS) | $34.80 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | 25% | 2,801 2014 Formulary | ||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Kaiser Permanente Senior Advantage Basic (HMO) | $39.00 | $3,400 | $0 | All Generics, Few Brands |
H9003 -006 -0 | $6.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
2014 Kaiser Permanente Senior Advantage Basic (HMO) | $39.00 | $4,900 | $0 | All Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
2013 ATRIO Silver (Willamette) (PPO) | $48.00 | $3,400 | No Rx Coverage | H7006 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 ATRIO Silver (Willamette) (PPO) | $44.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Health Net Aqua (PPO) | $45.00 | $2,500 | No Rx Coverage | H5520 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Health Net Aqua (PPO) | $45.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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2013 Regence MedAdvantage Basic (PPO) | $35.00 | $3,400 | No Rx Coverage | H3817 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Regence MedAdvantage Basic (PPO) | $49.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 AARP MedicareComplete Plan 1 (HMO) | $55.00 | $3,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H3805 -001 -0 | $3.00 | $6.00 | $44.00 | $44.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete Plan 1 (HMO) | $55.00 | $3,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $44.00 | $44.00 | 3,604 2014 Formulary | |||
2013 Providence Medicare Choice + RX (HMO-POS) | $52.00 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H9047 -024 -0 | $6.00 | $11.00 | $35.00 | $35.00 | 2,945 2013 Formulary | ||
2014 Providence Medicare Choice + RX (HMO-POS) | $61.00 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $11.00 | $45.00 | $45.00 | 2,859 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Regence MedAdvantage + Rx Classic (PPO) | $53.00 | $3,400 | $165 | No additional gap coverage, only the Donut Hole Discount | H3817 -002 -0 | $7.50 | $33.00 | $45.00 | $45.00 | 3,733 2013 Formulary | ||
2014 Regence MedAdvantage + Rx Classic (PPO) | $66.00 | $3,400 | $205 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $33.00 | $45.00 | $45.00 | 3,414 2014 Formulary | |||
2013 ODS Advantage PPO (PPO) | $57.00 | $3,400 | No Rx Coverage | H3813 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Moda Health PPO (PPO) | $67.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 ATRIO Silver Rx (Willamette) (PPO) | $81.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H7006 -003 -0 | $6.00 | $40.00 | $85.00 | $85.00 | 3,458 2013 Formulary | ||
2014 ATRIO Silver Rx (Willamette) (PPO) | $81.00 | $3,400 | $150 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $15.00 | $40.00 | $40.00 | 3,267 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 ODS Advantage PPORX (PPO) | $68.00 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | H3813 -006 -0 | $5.00 | $33.00 | $41.00 | $41.00 | 3,458 2013 Formulary | ||
2014 Moda Health PPORX (PPO) | $82.00 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $33.00 | $41.00 | $41.00 | 3,267 2014 Formulary | |||
2013 Salem Health Medicare, powered by ODS (PPO) | $70.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H3813 -004 -0 | $5.00 | $33.00 | $40.00 | $40.00 | 3,458 2013 Formulary | ||
2014 Salem Health Medicare, powered by Moda Health (PPO) | $88.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $33.00 | $40.00 | $40.00 | 3,267 2014 Formulary | |||
2013 Providence Medicare Extra (HMO) | $87.00 | $2,500 | No Rx Coverage | H9047 -033 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Providence Medicare Extra (HMO) | $92.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Health Net Violet Option 1 (PPO) | $99.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -002 -0 | $3.00 | $15.00 | $42.00 | $42.00 | 4,263 2013 Formulary | ||
2014 Health Net Violet Option 1 (PPO) | $109.00 | $2,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $42.00 | $42.00 | 4,195 2014 Formulary | |||
2013 Kaiser Permanente Senior Advantage (HMO) | $99.00 | $2,500 | $0 | All Generics, Few Brands |
H9003 -001 -0 | $6.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
2014 Kaiser Permanente Senior Advantage (HMO) | $109.00 | $2,500 | $0 | All Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
2013 ATRIO Gold Rx (Willamette) (PPO) | $112.70 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H7006 -001 -0 | $4.00 | $35.00 | $75.00 | $75.00 | 3,458 2013 Formulary | ||
2014 ATRIO Gold Rx (Willamette) (PPO) | $121.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $35.00 | $35.00 | 3,267 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Providence Medicare Extra + RX (HMO) | $133.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H9047 -001 -0 | $6.00 | $11.00 | $35.00 | $35.00 | 2,945 2013 Formulary | ||
2014 Providence Medicare Extra + RX (HMO) | $137.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $11.00 | $45.00 | $45.00 | 2,859 2014 Formulary | |||
2013 Regence MedAdvantage + Rx Enhanced (PPO) | $143.00 | $2,500 | $0 | Many Generics | H3817 -003 -0 | $5.00 | $33.00 | $45.00 | $45.00 | 3,733 2013 Formulary | ||
2014 Regence MedAdvantage + Rx Enhanced (PPO) | $178.00 | $2,500 | $0 | Many Generics | $5.00 | $33.00 | $45.00 | $45.00 | 3,414 2014 Formulary | |||
2013 Health Net Healthy Heart (PPO) | $159.00 | $2,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -009 -0 | $3.00 | $10.00 | $35.00 | $35.00 | 4,263 2013 Formulary | ||
2014 Health Net Healthy Heart (PPO) | $199.00 | $2,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $8.00 | $35.00 | $35.00 | 4,187 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 ATRIO Gold (Willamette) (PPO) | $75.00 | $2,500 | No Rx Coverage | H7006 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- Members will be assigned to ATRIO Silver (Willamette) (PPO) H7006-004 -- | ||||||||||||
2013 Health Net Violet Option 2 (PPO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -005 -0 | $3.00 | $20.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
-- Members will be assigned to Health Net Violet Option 2 (PPO) H5520-0012 -- | ||||||||||||
2013 ODS Advantage PPORX Select (PPO) | $139.00 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | H3813 -003 -0 | $5.00 | $33.00 | $41.00 | $41.00 | 3,458 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Providence Medicare Open + RX (PPO) | $188.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H5016 -001 -0 | $6.00 | $11.00 | $35.00 | $35.00 | 2,945 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Providence Medicare Open (PPO) | $133.00 | $2,500 | No Rx Coverage | H5016 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2014 -- |
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2013 Providence Medicare Extra Part B Only + RX (HMO) | $59.60 | n/a | $0 | n/a | H9047 -013 -0 | $6.00 | $11.00 | $35.00 | $35.00 | 2,945 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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