MEDICARE GUIDE Largest Portland-area Medicare managed care plans with drug coverage

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1 THE OREGONIAN OREGONLIVE.COM 1 Aetna Net Humana Moda care Monthly premium 2018/2019 Portland area: Aetna Medicare Choice PPO: NA/$17; Aetna Medicare NA/$47 Ruby $0/$0 in Violet 1 (PPO): $116/$120 in Violet 2 (PPO): $19/$19 in $0/$0 in Clark County (Wash.) Gold Plus HMO: $0/$0 in Portland area; $69/$69 in Deschutes Senior Advantage Basic $44/$44; Senior Advantage $127/$127 Moda : $119/$132; NA/$195 MyCare Rx 40 $23/$0; MyCare Rx 39 $76/$68 Prime + RX $0/$0; Choice + RX (HMO-POS): $88/$88; Extra + RX $165/$173 BlueAdvantage HMO: $0/$0; BlueAdvantage HMO Plus: $27/$35; MedAdvantage + Rx Primary PPO: NA/$19; MedAdvantage + Rx Classic PPO: $42/$48 or $93/$76. Call for details AARP Medicare- Complete 1 $73/$74 ($53/$55 in Linn ); AARP Medicare- Complete 2 $0/$0; AARP Medicare- Complete Choice (PPO): $33/$35 Providers in network(s) 9,000+ 7,000+ 3,084 in Portland area; 613 in Deschutes, Jefferson 3, ,000+ statewide 4,400+ Prime: 3,900+; All other plans: 16,000+ HMO: 5,500+; PPO: 8,500+ HMO: 3,900+ (1,300+ in Benton, etc.); PPO: 4,700+ Hospitals Legacy Legacy, Adventist, Peace- in Portland area and Clark County; others throughout service area Adventist, Tuality, Legacy, OHSU in St. Charles in Deschutes Sunnyside, Westside, Legacy Salmon Creek, Salem Hospital OHSU,, Legacy, Adventist, Tuality, Salem and most others in Oregon All Legacy hospitals, Tuality, Salem, Silverton, Willamette Valley, Peace SW Medical Center and others HMO: 25 hospitals; PPO: 44 hospitals HMOs: 26 hospitals including Adventist, Legacy, OHSU, and Tuality; PPO: Adventist, Legacy, OHSU, and Tuality County service areas Yamhill HMO and PPO: Benton, Douglas, Jackson, Josephine, Lane, Linn, Marion, Polk, Yamhill, Washington HMO only: Coos, Crook, Deschutes, Jefferson. PPO only: Clark (Wash.) Deschutes In Oregon: Columbia, Marion, Polk, Yamhill, parts of Benton and Linn; In Washington: Clark, Cowlitz, parts of Wahkiakum : All 36 Oregon ; Clatsop, Jackson, Josephine, Lincoln, Tillamook, Washington Washington Prime: Washington. Choice/Extra: Columbia, Lane, Marion, Polk, Yamhill and Clark (Wash.) HMOs: Clark (Wash.); PPO: Portland area, Benton, Columbia, Coos, Curry, Douglas, Jackson, Josephine, Lane, Linn, Marion, Polk, Yamhill, Clark HMOs: Benton, Lane, Linn, Marion, Polk, Yamhill; PPO: Lane, Marion, Yamhill

2 THE OREGONIAN OREGONLIVE.COM 2 Aetna Net Humana Moda care /drug plan quality rating (out of 5 stars) 2019 ratings had not been released by deadline. Check online at.gov for updates. deductible per year $0 Ruby $0; Violet 1: $185; Violet 2: $200 $0 $0 $0 $0 Prime: $100; Choice & Extra: $0 $0 $0 Hospital charges per day, in-network (unless otherwise noted) $375 days 1-4, then $0; $325 days 1-5; then $0 Ruby: $465 days 1-4, then $0; PPO in-network: Violet 1: $225 days 1-7, then $0; Violet 2: $375 days 1-4, then $0 $400 days 1-4, then $0 in Portland area; $395 days 1-4, then $0 in Deschutes Basic: $265 days 1-6, then $0; $200 days 1-6, then $0 : $295 days 1-5, then $0; $450 days 1-5, then $0 out-of-network; $150 days 1-5, then $0; $300 days 1-5, then $0 out-of-network $370 days 1-5, then $0 $295 days 1-5, then $0 Prime: days 1-4 $450, then $0. days 1-6 $300, then $0; Extra: days 1-5 $250, then $0 HMO: $430 days 1-4; HMO Plus: $375 days 1-4; Primary PPO: $400 days 1-4; Classic PPO: $395 days 1-4. HMO 1: $285 days 1-7 ($195 Linn ); HMO 2: $430 days 1-4 ($425 Benton, Lane, Linn); PPO: $350 days 1-5 in-network ($430 days 1-24 out) Doctor charges per visit, primary/ specialist $0/$40; Aetna Medicare $0/$30 Ruby: $0/$45; Violet 1: $12/ $25; Violet 2: $15/$30 or $15/$35 $0/$40 Basic: $25/$35; $15/$25 : $25/$35; $0/$20 $0/$35 $0/$25 Prime: $0/$40; $15/$30; Extra: $10/$20 HMO: $5/$40; HMO Plus: $0/$35; Primary PPO: $15/$45; Classic PPO: $10/$40 HMO 1: $0/$25 ($0/$30; Linn ); HMO 2: $5/$40; PPO: $0/$30 in-network ($25/$50 out) Maximum out-ofpocket per year; in-network/inand out-of network combined $4,900/ $10,000; $5,200/ $10,000 Ruby: $3,900; Violet 1: $2,900/ $4,000; Violet 2: $5,550/ $6,600 or $6,700/ $8,700 $5,700 in-network in Portland area, $5,500 in Deschutes Basic: $4,900; $2,500 : $3,900; $2,500 $4,950 Prime: $5,500; $4,500/$6,700; Extra: $3,400 HMO: $5,500; HMO Plus $4,900; Primary PPO: $6,700/ $10,000; Classic PPO: $6,000/ $10,000. HMO 1: $3,500 ($2,900 Benton, Lane, Linn ); HMO 2: $5,900 ($4,100 Linn); PPO: $4,900/ $10,000 Emergency care co-pay $90, worldwide, waived if admitted Ruby & Violet 2: $90: Violet 1 & Aqua: $120; $0 worldwide $90, waived if admitted within 24 hrs. $75 worldwide, $65 worldwide, in 24 hrs. $90 worldwide, waived if admitted with in 72 hrs. $90 worldwide, within 24 hrs. $90 worldwide, waived if admitted within 48 hrs. $90 worldwide, within 24 hrs.

3 THE OREGONIAN OREGONLIVE.COM 3 Aetna Net Humana Moda care Drug deductible Tiers 4-5 only: $145 $95 $95 to $150 Tiers 3-5 only: $150 in Portland, $100 elsewhere $0 $120 $200; MyCare Rx 39: $150 Prime: $270; $240; Extra: $0 HMO Plus: $0 all tiers. Tiers 3-5 only: HMO $200; Primary: $300; Classic: $250 $ Drug co-pays for Tier 1: preferred generics Tier 2: non-prefered generics Tier 3: preferred brand Tier 4: non-preferred brand Tier 5: specialty Tier 6: select care drugs Gap coverage: This year, you ll pay 25% of the cost of select brand-name drugs and 37% of generics gap coverage Tiers 1 and 2 preferred/ non-preferred. Tier 1: $0/$15 /$20 (Choice); 31% (Select) Mail-order discounts Portland area, preferred network. Ruby: Tier 2: $8 ; Violet 1: Tier 1: $5 Tier 5: 31% Violet 2: Tier 1: $5 Tier 2: $15 Preferred pharmacy network. In Portland area Tier 1: $2 Tier 2: $8 In Deschutes Tier 1: $4 Tier 2: $15 Tier 5: 31% Tier 1: $5 Tier 3: $45 Tier 5: 33% injectable Part D vaccines Gap coverage: Tiers 1 and 2: $5/$10 Tiers 3-5: 25% Mail-order discounts Tier 1: $2 Tier 2: $20 Tier 3: $45 Tier 4: 31% Tier 5: 29% Tier 1: $2 Tier 4: 31% Coverage through gap for Tier 3 (partial gap coverage) and Tier 6 (full gap coverage) Prime: Tier 1: $0 Tier 5: 27% Tier 1: $4 Tier 2: $13 Tier 5: 28% Extra: Tier 1: $4 Tier 5: 33% Preferred pharmacy network; mail order. HMO: Tier 3: $40 Tier 4: 40% Tier 5: 29% HMO Plus: Tier 2: $8 Tier 3: $40 Tier 4: 40% Tier 5: 33% PPOs: Tier 2: $13 Tier 3: $40 Tier 4: 40% Tier 5 Primary PPO: 27% Tier 5 Classic PPO: 28% HMO plans: Tier 1: $4/($3, Linn ) Tier 5: 27%- 29% PPO plan: Tier 3: $45 Tier 4: $95 Tier 5: 29% Outpatient surgery (ASC = ambulatory surgical center) $325 $225 Based on place of service (ASC or hospital). Call for details $200 ASC in-network Basic: $210; $125 : $295; $100 $225 Prime: $450 $250 Extra: $150 HMO Plus: 20%, ASC $275; HMO and PPOs: 20%, ASC 15% Varies by plan: $175-$430 (PPO in-network) Chemotherapy cost-share 20% Ruby: 20%; Violet 1: 17% Violet 2: 18% or 19% in-network 20% in-network Basic: 0-15%; 0-15% 20% 30% out-ofnetwork 20% 20% 20% 20% PPO: 30% outof-network

4 THE OREGONIAN OREGONLIVE.COM 4 Aetna Net Humana Moda care Durable equip. (wheelchairs, oxygen, etc.) 20% Ruby: 20%; Violet 1: 17% Violet 2: 18% or 19% in-network 20% in-network 0%-20% 20% 30% outof-network 20% 20% 20% 20% PPO: 50% outof-network Skilled nursing co-pay per day (no coverage after 100 days) $172 days 1-20: $0; $170 PPO: $220 out-of-network In-network: days 21-55: $172, days : $0 Basic: $50; days 1-100: $0 $150 $172 Prime: days 1-20: $0, : $172; days 1-20: $0, : $160; Extra: : $150 HMOs: days 1-20: $0, days : $167; PPOs: days 1-20: $0, days : $160 (Classic) or $167 (Primary) Day limits vary by plan. Days 1-20: $0, days 21-39(-57): $160, days 40(-58)- 100: $0. Routine eye exams, eyewear $0 annual exam, $100 annual hardware allowance; $0 annual exam, $150 annual hardware allowance Ruby, Violet 1: $10 annual exam, $250 eyewear allowance every 24 months; Violet 2: Buy-up $0 routine exam per year; $300 allowance for contacts or eyeglasses in Portland, $100 in Deschutes Basic: $35 exams; Senior Advantage: $25. See optional for eyewear $0 co-pay exam, $0 co-pay vision hardware every 2 years $20 eye exam, $200 eyewear allowance every 2 years; $25 eye exam, $200 eyewear allowance every 2 years Prime: $30 annual exam allowance, $75 eyewear allowance every 2 years; Choice & Extra: $60 annual exam allowance, $250 eyewear allowance every year HMO Plus: $0 exam, $100 eyewear allowance; Classic PPO: $0 exam, $100 eyewear allowance; HMO and Primary PPO: Optional HMO plans: $20 annual exam, $0 eyewear copay, up to $70 credit for frames (standard lenses included) or $105 credit for contacts every 2 years; PPO: $20 exam in-network Supplemental routine hearing exam co-pay/ hearing aids $0 exam per year; $1,000 hearing aid allowance per year Included for Ruby (HMO) members. $0 exam, $0-$1,580 per aid $0 exam, up to 3 fittings per year, $499 or $799 per ear per year Basic: $35 exams; Senior Advantage: $25. See optional for hearing aids $45 exams, $699-$999 co-pay per aid $45 annual exam, $699/$999 co-pay per aid $45 exam, $699- $999 per aid through optional HMO 1 & PPO (in-network): $0; HMO 2: $5 exam. Hearing aids, all plans: $330-$380, 2 per year Mental health per visit, individual/group $40 copay Ruby: $35-$40; PPO (in-network) Violet 1 $25; Violet 2 $30-$35 $40-$55 Basic: $25/$12; $15/$7 : $25 in-network, $40 out; $20 in, $40 out $35 MyCare Rx 39: $15 Prime: $40 $30 Extra: $20 HMO: $5-$40; HMO Plus: $0-$35; Primary PPO: $40; Classic PPO: $40 $40/$30 PPO: $45/$35 out-of-network Members New in ,000+ 6,000 60, ,000 14, , , ,000+

5 THE OREGONIAN OREGONLIVE.COM 5 Aetna Net Humana Moda care Other details SilverSneakers fitness benefit; $0 in-network PCP visits and lab services; embedded dental allowance; no referrals for in- or out-of- network services; Resources For Living referral service. Silver&Fit program, Worldwide Emergency, Telehealth included on all plans; routine chiropractic, acupuncture, naturopathy included on some plans; dental/vision buy-ups. Call for details. $0 Tier 1&2 90-day preferred mail order Rx, Tier 1 ED drugs, SilverSneakers, acupuncture, over-the-counter allowance, 24-hour nurse hotline, post-hospital discharge meal benefit, $0 phone/video doctor and mental health consults Advantage Plus: Dental, eyewear and hearing aid optional package for additional $44/month; cost for gym membership and Silver&Fit fitness program; outside service area benefit All plans include $500 dental benefit for comprehensive, preventive care. Chiropractic, naturopathic and acupuncture benefits for extra $6/month; 12-month travel benefit; free gym membership and home fitness kits through Silver&Fit Acupuncture, chiropractic, and naturopathy benefits; $0 gym membership; $0 colonoscopies; $0 bone density exams (DEXA); $0 chronic-care and transition-care management; mail-order prescription discount Rx deductible waived on generic tiers; Silver&Fit free gym membership; $0 online video visits with Express Care Virtual; optional dental plans start at $33.70/ month; 24-hour nurse line Silver&Fit on all plans; HMO and Primary PPO optional benefits: $20/month (preventive dental, vision and hearing); HMO Plus and Classic PPO optional benefits: $28/ month (comprehensive dental and hearing). *PPO cost shares are for in-network. $0 Tier 1 90-day preferred mail order Rx; chiropractic/ acupuncture benefit ( 1 and PPO); dental riders: $34-$39; Renew Active Fitness $0 (all plans); Solutions for Caregivers $0; HouseCalls visit $0; 24-hour nurse line; PPO Passport option. Telephone UHC-6509 TTY 711 Website aetna.com or.healthnet advantage.com humana.com/ kp.org/ modahealth. com/. pacificsource. com providence health assurance.com regence.com/ uhc health plans.com Other Medicare Advantage plan providers Within Portland area Outside Portland area Humana Community of Washington ATRIO s AllCare Advantage Samaritan Advantage Type of plan Local HMO & PPO Local HMO Local PPO Local HMO Local HMO Counties served Benton, Columbia, Crook, Deschutes, Hood River, Jefferson, Lincoln, Linn, Malheur, Polk, Washington Clark (Wash.) Douglas, Jackson, Josephine, Klamath, Marion, Polk Douglas, Jackson, Josephine Benton, Lincoln, Linn Phone TTY: TTY: TTY: Website humana-.com healthfirst.chpw.org atriohp.com allcareadvantagehp.com.samhealthplans.org

6 Medicare Part D plans THE OREGONIAN OREGONLIVE.COM 6 Aetna Asuris rthwest Cigna- Spring Rx Envision- Insurance Co. Express Scripts Humana (Walmart) Mutual of Omaha Rx SilverScript Insurance care WellCare Phone TTY: TTY: Website aetna.com asuris.com cigna.com/ envision rxplus.com expressscripts. com/ humana.com/ mutualof omaha.com silverscript. com uhc solutions.com wellcarepdp.com Monthly premium 2018/ 2019 $32.60/ $32.50 Select: NA/$15.40 Value Plus: NA/$58.70 Basic: $100/ $90.50 $160.50/$117 Secure: $28.70/$27.80 Secure- Essential: NA/$21.80 Secure-Extra: $49.40/ $49.40 (Formerly Silver): $12.60/$14.50 Value: $49.60/ $47.20 $88.60/ $90 $22.60/$24 Walmart: $20.40/ $26.60 Preferred: $32.50/$34 $73.80/ $73.80 Plus: NA/$45 Value: NA/$25.40 $30.40/ $32.50 Plus: $69.10/ $65.80 Saver Plus: $44.80/$33.80 Preferred: $86.20/$76 Walgreens: $26.70/$28 Classic: $30.30/$33.40 Extra: N/A/$69.80 Value Script: $37.20/$16.90 Annual deductible 2018/ 2019 $320/$320 Select: NA/$370 Value Plus: NA/$0 Basic: $210/$135 $0/$0 Secure: NA/ $405/ $415 Secure-Essential: NA/$415 Secure-Extra: $0/$100 (Formerly Silver): $300/$365 Value: $350/$350 Walmart: Preferred: $0 NA/$415 NA/$415 $0 Saver Plus: Preferred: $0 Walgreens: Classic: Extra: N/A/$0 Value Script: Coverage in gap Select & Value Plus: Yes Basic: Yes Secure: Secure- Essential: Value: Yes Plus: Yes Secure- Extra: Yes