2012 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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CareSource Silver (HMO) - H3810-006-0 Benefit Details |
Josephine | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Health Net Violet Option 2 (PPO) - H5520-006-0 Benefit Details |
Josephine | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
Regence MedAdvantage Basic (PPO) - H3817-001-0 Benefit Details |
Josephine | $35.00 | 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 |
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Service | Exper. | Cost Info | |||||||||
CareOregon Advantage Plus (HMO-POS SNP) - H5859-001-0 Benefit Details |
Josephine | $ 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 |
Josephine | $36.40 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: 25% | $6,700 Browse Formulary | |||||
CareSource - SNP (HMO SNP) - H3810-002-0 Benefit Details |
Josephine | $ 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 | |||||
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 | |||||||||
CareSource Bronze Rx (HMO) - H3810-019-0 Benefit Details |
Josephine | $36.40 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $6,700 Browse Formulary | |||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Josephine | $40.60 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Health Net Aqua (PPO) - H5520-003-0 Benefit Details |
Josephine | $49.00 | 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 | |||||||||
Regence MedAdvantage + Rx Classic (PPO) - H3817-002-0 Benefit Details |
Josephine | $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 | |||||
CareSource Gold (HMO) - H3810-001-0 Benefit Details |
Josephine | $74.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,000 | ||||||
CareSource Silver Plus Rx (HMO) - H3810-007-0 Benefit Details |
Josephine | $80.50 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $29.00 Tier 3: $39.00 Tier 4: $69.00 Tier 5: 33% | $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 | |||||||||
Health Net Violet Option 1 (PPO) - H5520-004-0 Benefit Details |
Josephine | $95.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $2,500 Browse Formulary | |||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Josephine | $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 | |||||
Health Net Healthy Heart (PPO) - H5520-010-0 Benefit Details |
Josephine | $129.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $1,750 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 | |||||||||
CareSource Platinum (HMO-POS) - H3810-004-0 Benefit Details |
Josephine | $132.90 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,000 | ||||||
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Josephine | $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 | |||||
CareSource Gold Plus Rx (HMO) - H3810-003-0 Benefit Details |
Josephine | $135.20 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $29.00 Tier 3: $39.00 Tier 4: $69.00 Tier 5: 33% | $2,000 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 | |||||||||
CareSource Platinum Plus Rx (HMO-POS) - H3810-005-0 Benefit Details |
Josephine | $199.20 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $29.00 Tier 3: $39.00 Tier 4: $69.00 Tier 5: 33% | $1,000 Browse Formulary | |||||
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