2011 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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AARP MedicareComplete Choice (PPO) - H3812-001-0 Benefit Details |
Clackamas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $80.00 Specialty Tier Drugs: 33% | $3,900 Browse Formulary | |||||
AARP MedicareComplete Plus (HMO-POS) - H1286-004-0 Benefit Details |
Clackamas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $80.00 Specialty Tier Drugs: 33% | $3,900 Browse Formulary | |||||
Health Net Violet Option 2 (PPO) - H5520-005-0 Sanctioned Plan |
Clackamas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $7.00 Preferred Brand Drugs: $41.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $3,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H8145-097 (PFFS) - H8145-097-0 Benefit Details |
Clackamas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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PremierCare Choice (HMO) - H3818-004-0 Benefit Details |
Clackamas | $21.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Evercare Plan IP (PPO SNP) - H3812-005-0 Benefit Details |
Clackamas | $28.90 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
CareOregon Advantage Plus (HMO-POS SNP) - H5859-001-0 Benefit Details |
Clackamas | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
CareOregon Advantage Star (HMO-POS) - H5859-003-0 Benefit Details |
Clackamas | $35.30 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
PremierCare Plus (HMO SNP) - H3818-002-0 Benefit Details |
Clackamas | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Health Net Aqua (PPO) - H5520-001-0 Sanctioned Plan |
Clackamas | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Providence Medicare Choice (HMO-POS) - H9047-035-0 Benefit Details |
Clackamas | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
PremierCare Choice Rx (HMO) - H3818-003-0 Benefit Details |
Clackamas | $44.00 | $175 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Generic and Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 28% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Regence MedAdvantage (PPO) - H3817-001-0 Benefit Details |
Clackamas | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Kaiser Permanente Senior Advantage Basic (HMO) - H9003-006-0 Benefit Details |
Clackamas | $47.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $45.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
Health Net Ruby (HMO) - H6815-001-0 Sanctioned Plan |
Clackamas | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Preferred Brand Drugs: $38.00 Non-Preferred Generic and Non-Preferred Brand Drug: $76.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $2,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Clackamas | $64.10 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
AARP MedicareComplete (HMO) - H3805-001-0 Benefit Details |
Clackamas | $65.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $80.00 Specialty Tier Drugs: 33% | $4,900 Browse Formulary | |||||
Humana Gold Choice H8145-093 (PFFS) - H8145-093-0 Benefit Details |
Clackamas | $67.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $6.00 Non-Preferred Generic and Preferred Brand Drugs: $36.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Providence Medicare Choice + RX (HMO-POS) - H9047-024-0 Benefit Details |
Clackamas | $71.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H3817-002-0 Benefit Details |
Clackamas | $80.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Non-Preferred Generic Drugs: $35.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $75.00 Injectable Drugs: 30% Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Providence Medicare Extra (HMO) - H9047-033-0 Benefit Details |
Clackamas | $87.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Providence Medicare Open (PPO) - H5016-002-0 Benefit Details |
Clackamas | $90.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
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PremierCare Value Rx (HMO) - H3818-014-0 Benefit Details |
Clackamas | $95.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Generic and Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 30% | $2,500 Browse Formulary | |||||
Health Net Violet Option 1 (PPO) - H5520-002-0 Sanctioned Plan |
Clackamas | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Preferred Brand Drugs: $38.00 Non-Preferred Generic and Non-Preferred Brand Drug: $76.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $2,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Kaiser Permanente Senior Advantage (HMO) - H9003-001-0 Benefit Details |
Clackamas | $107.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $45.00 Specialty Tier Drugs: 25% | $2,500 Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Clackamas | $127.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Non-Preferred Generic Drugs: $35.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $75.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $2,500 Browse Formulary | |||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Clackamas | $127.30 | $120 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: 10% Generic and Brand Drugs: 32% Brand Drugs: 50% Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Providence Medicare Extra + RX (HMO) - H9047-001-0 Benefit Details |
Clackamas | $128.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $2,500 Browse Formulary | |||||
Health Net Healthy Heart (PPO) - H5520-009-0 Sanctioned Plan |
Clackamas | $139.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $70.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $1,750 Browse Formulary | |||||
PremierCare Advantage Rx (HMO) - H3818-001-0 Benefit Details |
Clackamas | $140.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Generic and Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 30% | $2,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
PremierCare Select Rx (HMO SNP) - H3818-015-0 Benefit Details |
Clackamas | $144.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic, Preferred Brand and Non-Preferred Brand D: 0% Generic Drugs: $7.00 Generic and Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $60.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
Providence Medicare Open + RX (PPO) - H5016-001-0 Benefit Details |
Clackamas | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $2,500 Browse Formulary | |||||
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