2014 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 Plan 2 (HMO) - H3805-012-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
ATRIO Bronze (Willamette) (PPO) - H7006-006-0 Benefit Details |
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Health Net Jade (HMO SNP) - H6815-002-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $38.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Tier 6: $0.00 | n/a 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 | |||||||||
Health Net Ruby (HMO) - H6815-001-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $38.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Tier 6: $0.00 | $2,500 Browse Formulary | |||||
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HumanaChoice H6609-070 (PPO) - H6609-070-0 Benefit Details |
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
ATRIO Bronze Rx (Willamette) (PPO) - H7006-005-0 Benefit Details |
Polk | $17.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 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 2 (PPO) - H5520-012-3 Benefit Details |
Polk | $19.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Tier 6: $0.00 | $6,000 Browse Formulary | |||||
Regence BlueAdvantage HMO (HMO) - H6237-002-0 Benefit Details |
Polk | $19.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 27% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
Providence Medicare Choice (HMO-POS) - H9047-035-0 Benefit Details |
Polk | $28.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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 | |||||||||
ATRIO Special Needs Plan (Willamette) (HMO SNP) - H5995-001-0 Benefit Details |
Polk | $0.00 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% | n/a Browse Formulary | |||||
CareOregon Advantage Plus (HMO-POS SNP) - H5859-001-0 Benefit Details |
Polk | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Some Generics | Preferred Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% | n/a Browse Formulary | |||||
CareOregon Advantage Star (HMO-POS) - H5859-003-0 Benefit Details |
Polk | $34.80 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: 25% | $6,700 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 Basic (HMO) - H9003-006-0 Benefit Details |
Polk | $39.00 | $0 | All Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% Tier 6: $0.00 | $4,900 Browse Formulary | |||||
ATRIO Silver (Willamette) (PPO) - H7006-004-0 Benefit Details |
Polk | $44.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Health Net Aqua (PPO) - H5520-001-0 Benefit Details |
Polk | $45.00 | 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 Basic (PPO) - H3817-001-0 Benefit Details |
Polk | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
AARP MedicareComplete Plan 1 (HMO) - H3805-001-0 Benefit Details |
Polk | $55.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $44.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,500 Browse Formulary | |||||
Providence Medicare Choice + RX (HMO-POS) - H9047-024-0 Benefit Details |
Polk | $61.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $11.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: 33% Select Care Drugs: 33% | $3,000 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
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 |
Polk | $66.00 | $205 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 27% | $3,400 Browse Formulary | |||||
Moda Health PPO (PPO) - H3813-001-0 Benefit Details |
Polk | $67.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
ATRIO Silver Rx (Willamette) (PPO) - H7006-003-0 Benefit Details |
Polk | $81.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 29% | $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 | |||||||||
Moda Health PPORX (PPO) - H3813-006-0 Benefit Details |
Polk | $82.00 | $120 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $33.00 Preferred Brand: $41.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Salem Health Medicare, powered by Moda Health (PPO) - H3813-004-0 Benefit Details |
Polk | $88.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $33.00 Preferred Brand: $40.00 Non-Preferred Brand: 50% Specialty Tier: 33% | $2,500 Browse Formulary | |||||
Providence Medicare Extra (HMO) - H9047-033-0 Benefit Details |
Polk | $92.00 | 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 | |||||||||
Health Net Violet Option 1 (PPO) - H5520-002-0 Benefit Details |
Polk | $109.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $2,700 Browse Formulary | |||||
Kaiser Permanente Senior Advantage (HMO) - H9003-001-0 Benefit Details |
Polk | $109.00 | $0 | All Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% Tier 6: $0.00 | $2,500 Browse Formulary | |||||
ATRIO Gold Rx (Willamette) (PPO) - H7006-001-0 Benefit Details |
Polk | $121.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $75.00 Specialty Tier: 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 | |||||||||
Providence Medicare Extra + RX (HMO) - H9047-001-0 Benefit Details |
Polk | $137.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $11.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: 33% Specialty Tier: 33% | $2,500 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Polk | $178.00 | $0 | Many Generics | Preferred Generic: $5.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $2,500 Browse Formulary | |||||
Health Net Healthy Heart (PPO) - H5520-009-0 Benefit Details |
Polk | $199.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $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 | |||||||||
HumanaChoice H6609-073 (PPO) - H6609-073-0 Benefit Details |
Polk | $205.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | $6,700 Browse Formulary | |||||
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