2012 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Regence MedAdvantage Basic (PPO) - H3817-001-0 Benefit Details |
Clatsop | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
CareOregon Advantage Plus (HMO-POS SNP) - H5859-001-0 Benefit Details |
Clatsop | $ 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: 15% Tier 2: 15% | n/a Browse Formulary | |||||
CareOregon Advantage Star (HMO-POS) - H5859-003-0 Benefit Details |
Clatsop | $36.40 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: 25% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
PremierCare Plus (HMO SNP) - H3818-002-0 Benefit Details |
Clatsop | $ 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: 15% Tier 2: 15% | n/a Browse Formulary | |||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Clatsop | $40.60 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
PremierCare Choice (HMO) - H3818-004-0 Benefit Details |
Clatsop | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Regence MedAdvantage + Rx Classic (PPO) - H3817-002-0 Benefit Details |
Clatsop | $67.00 | $160 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.50 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 29% Tier 6: 29% | $3,400 Browse Formulary | |||||
PremierCare Choice Rx (HMO) - H3818-003-0 Benefit Details |
Clatsop | $74.00 | $190 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $30.00 Tier 3: $65.00 Tier 4: 28% | $3,400 Browse Formulary | |||||
PremierCare Value Rx (HMO) - H3818-014-0 Benefit Details |
Clatsop | $125.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $30.00 Tier 3: $70.00 Tier 4: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Clatsop | $128.30 | $120 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $33.00 Tier 3: $40.00 Tier 4: 50% Tier 5: 30% | $3,400 Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Clatsop | $135.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 33% Tier 6: 33% | $2,500 Browse Formulary | |||||
|