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

Transcription

1 SPONSORED BY MEDICARE GUIDE Largest Portland-area managed care plans with drug coverage Moda Monthly premium 2015/2016 Advantage Star $33.80/$33.80 Ruby (HMO): $0/$0 Violet Option 1 (PPO): $116/$116 Violet Option 2 (PPO): $0/$0 in Clark (Wash.), $19 in Portland area. Call for details. Senior Advantage Basic (HMO): $41/$41; Senior Advantage (HMO) $112/$119 Moda Health PPORX: $70/$97 Prime + Rx $0/$0; Choice + Rx $77/$81; Extra + Rx (HMO): $147/$157 PPO premiums vary by county. MedAdvantage + Rx Classic PPO: $44/$46 or $102/$104; MedAdvantage + Rx Enhanced PPO: $188/$201 or $208/$242; BlueAdvantage HMO: $0/$0 Complete Plan 1 (HMO): $70/$70 ($49/$49 in Benton, Lane, Linn counties); Complete Plan 2 (HMO): $0/$0; - Complete Choice (PPO): $45/$35 (HMO): $0/$0; Select Rx (HMO): $140/$136 MyCare Rx 22 (HMO): $47/$38 Gold Plus (HMO): $0/$0 in Portland metro; $64/$73 in Deschutes & Jefferson; Choice (PPO): $95/$104 Doctors, others 4,000 More than 6,000 More than 4,000 Statewide network 9,500+ Prime: 4,500 Others: 11,000+ HMO: 8,100+ PPOs: 19,000+ More than 10,000 More than 4,000 More than 3,000 2,500 Hospitals Adventist, OHSU, Legacy, Tuality, hospitals in metro area; others Adventist, Legacy, Tuality, hospitals in metro area; others Sunnyside, Westside Medical Center, Legacy Salmon Creek, Salem Hospital OHSU,, Legacy, Salem Health and most others in, Tuality, Salem, Silverton, Willamette Valley, Southwest Medical Center and others HMO: 12 hospitals PPOs: 38 hospitals HMOs: 30 hospitals including Adventist, Legacy, and Tuality PPO: Adventist, Legacy, Tuality Legacy Mount Hood, Emanuel, Good Samaritan, Meridian Park, Adventist, others OHSU, Legacy Mount Hood, Emanuel, Good Samaritan, Meridian Park, Tuality Community, Forest Grove Adventist, Tuality, OHSU in Portland metro; St. Charles in Deschutes, Jefferson, Crook Page 1 of 5

2 MEDICARE GUIDE Largest Portland-area managed care plans with drug coverage Moda County s Clatsop,, Jackson, Josephine, Marion, Polk, Tillamook, Yamhill Product variations available in 13 counties, including Portland area, Clark () Marion, Polk,, Yamhill, parts of Benton and Linn; Clark, Cowlitz, parts of Lewis and Wahkiakum in All 36 counties Prime: Choice/Extra: Lane, Marion, Polk,, Yamhill, Clark Marion, Polk, Clark PPOs: Portland metro, Benton, Coos, Curry, Douglas, Jackson, Josephine, Lane, Linn, Marion, Polk, Wasco, Yamhill, Clark HMOs: Benton, Lane, Linn, Marion, Polk, PPO: Lane, Marion,, Yamhill Clatsop, Morrow, Umatilla, HMO:, Clackamas; HMO/PPO: Deschutes, Jefferson Plan quality rating (out of 5) rrrr HMO: rrrrr PPOs: rrrr rrrrr rrrr rrrrr PPOs: rrrrr HMO: Not yet rated PPO: rrrrr HMOs: rrrr rrrr rrrr rrrr Plan deductible per year $150 inpatient hospital only Ruby $0; Violet 1 /2: $225/$250 $0 $125 Prime: $195 Choice/Extra: $0 $0 $0 $0 $0 $0 Hospital charges (unless otherwise noted) $315 first 5 days, Ruby: $375 first 5 days, ; $225 first 7 days, ; $375 first 4 days, Basic: $275 first 6 days, ; Senior Advantage: $200 first 6 days, then $0 $295 days 1-5, ; $400 days 1-5 out-of-network Prime: $275 ($30% out-ofnetwork) days 1-7, ; Choice: $275 (20% out-ofnetwork) days 1-7, ; Extra: $200 days 1-7, HMO: $300 days 1-6 or $390 days 1-4 (nonmetro), ; Classic PPO: $390 days 1-4, ; $310 days 1-5, $250 days 1-7 ($195 Benton, Lane, Linn), then $0; HMO Plan 2: $430 days 1-4, ; PPO: $335 days 1-5 ($430 days 1-24 out), $275 days 1-6, $0 after; $225 days 1-6, $0 after $295 days 1-5, Gold Plus HMO: $325 days 1-5, $0 days 6-60, $100 days 61-90; Choice: $300 days 1-5, $0 days 6-60, $100 days Page 2 of 5

3 MEDICARE GUIDE Largest Portland-area managed care plans with drug coverage Moda Doctor charges, per visit, ; primary/ specialist $10 primary/ $30 specialist; out-of-network: $25/$45 Ruby: $5/$30; $12/$25; $15/$30 Basic: $30/$35; $20/$25 $25/$35 Prime: $20/$40; Choice: $20/$30; Extra: $15/$20 $0/$30; HMO $15/$35; Classic: $15/$40 Enhanced: $10/ $25. $0/$20 ($0/$30 Linn); HMO Plan 2: $0/$35; PPO: $0/$40 $5/$40; $5/$40 $5/$25 HMO: $0/$40 ($10/$40 in Deschutes, Jefferson); PPO: $10/$5 Maximum out-of-pocket per year / in- and outof-network combined $6,700 (same for or out-of-network) Ruby: $3,400; $2,900/$4,000; $5,550/$6,600 or $5,600/$6,600 Basic: $4,900; $2,500 $3,400 Prime: $6,700; Choice: $3,250/$4,250; Extra: $3,000 $3,400; HMO $6,700; Classic PPO: $6,700/ $10,000*; $5,000/$8,300* $3,500 ($3,750 Linn); HMO Plan 2: $5,900; PPO: $4,900/$10,000 $6,700; $3,400 $3,400 Gold Plus HMO: $5700 ($4,900 in Deschutes, Jefferson); Choice PPO: $6,700 Emergency care co-pay $75 nationwide $75 worldwide, admitted Basic: $75 worldwide; Senior Advantage: $75 $65 worldwide, $65 worldwide, $75 worldwide, admitted in 48 $75 worldwide $75 worldwide, $75, waived if admitted $75, admitted within 24 Drug deductible $300 Tiers 2-6 only $ Tiers 3,4,5; Others $0 $0 $120 Prime: $90; Others: $0 Classic: $360; Others: $0 $ Tiers 3, 4, and 5 only $200; $100 $0 HMO: $320 Tiers 4 & 5 only Page 3 of 5

4 MEDICARE GUIDE Largest Portland-area managed care plans with drug coverage Moda Drug co-pays Tier 1 - preferred generics Tier 2 - nonprfrd generics Tier 3 - prfrd brand Tier 4 - nonprfrd brand Tier 5 - specialty Tier 6 - select care drugs Gap: You ll pay 45% of brand-name drugs & 58% of generics Tier 1: $4 Tier 2: $20 Tier 5: $100 Tier 6: 25% of the cost Ruby: Tier 1: $3, Tier 2: $8, Tier 3: $37, Tier 4: $90, Tier 5: 30%, Tier 6: $0 $10, Tier 3: $37, Tier 4: $90, Tier 5: 31%, Tier 6: $0 $15, Tier 3: $37, Tier 4: $90, Tier 5: 28%, Tier 6: $0 Tier 1: $5 Tier 2: $10 Tier 4: $90 Tier 5: 33% Gap coverage: Tiers 1 /2: $5/$10; mailorder discounts Tier 1: $2 Tier 2: $10 Tier 4: 50% Tier 5: 30% Choice/Extra: Tier 1: $6-$12, -$20, Tier 3: $47, Tier 4: $95, Tier 5/6: 33% Prime: Tier 1: $7-$12, Tier 2: $15-$20, Tier 3: $47,, Tier 5/6: 30% HMOs: Tier 1: $5, Tier 2: $12, Tier 3: $45,, Tier 5: 33%, Tier 6: $0 Classic PPO: Tier 1: $10,, Tier 3: $47, Tier 4: $100,, Tier 6: $0 $12, Tier 3: $47, Tier 4: $100, Tier 5: 33%, Tier 6: $0 All Plans: Tier 1: $2 Tier 2: $8/($10, HMO Plan 2 in Linn) Tier 5: 27%-29% Tier 1: $0 Tier 2: $20 Tier 3: $35 Tier 4: $90 Tier 5: 28% Tier 1: $0 Tier 2: $7 Tier 3: $30 Tier 4: $70 Tier 5: 30% Tier 1: Preferred Pharmacy $0/Standard Pharmacy $5 Tier 2: Pref $12/ Stand $17 Tier 3: Pref $37/ Stand $47 Tier 4: Pref $90/ Stand $100 Tier 5: 33% Tier 6: $0; additional gap coverage for select brand and generic drugs HMO Portland: Tier 1: $3 HMO Deschutes, Jefferson: Tier 1: $5 PPO: Tier 1: $4 Routine eye exams/ eyeglasses $20 per year exams; $0 lenses every 2 years, plus up to $75 toward frames or contact lenses every 2 years Ruby, Violet Option 1: $10 exam; $250 eyewear allowance every 2 years buy-up available Basic: $35 exams; $25; See optional package for eyewear in other details section $35 exam; vision hardware available with extra care buy-up Prime: See other details section; Choice exam: $20 (up to $45 out-of-network); Extra exam: $15; Choice/Extra glasses: $100 every 2 years $0 exam, $100 eyewear; HMO $15 exam, $65 eyewear; Classic: $40 exam, $100 eyewear; Enhanced: $25 exam, $150 eyewear HMO plans: $20-$35 annual exam (varies by plan); $0 standard lenses with up to $70 credit for frames every 2 yrs; PPO: $40 exam only exam: $20; Select Rx exam: $0; $100 glasses credit all plans $25 exams; $100 every 2 years for eyewear HMO: Annual exam $0; Contact lenses, eyeglasses $0; up to $100 every year. PPO: $40 every year for routine eye exam Skilled nursing co-pay (no coverage after 100 days) : $ : $100 in network/ppo; $150 out of network Basic: : $50; Days 1-100: $ : $100 Prime: Days 1-20: $0; : $160; 30% out-ofnetwork. Choice: Days 1-20: $0, : $150; 20% out; Extra: Days 1-20: $0, : $150 days 1-20: $40, days : $150; days 1-20: $0, days : $160; PPOs: days 1-20: $0, days : $160 Day limits vary by plan (-57): $160; 43(-58)-100: $0. Call for details : $125; Days 1-20: $ : $ : $0 Days 1-20: $40; : $ : $160 Page 4 of 5

5 MEDICARE GUIDE Largest Portland-area managed care plans with drug coverage Moda Supplemental routine hearing exam co-pay/ hearing aids Optional buy-up available to HMO members Basic: $35 exams; Senior Advantage: $25. see other details section Available with extra care buy-up for HMOs or Classic; Enhanced: $599 or $899 copay for hearing aid All Plans: $0 exam. $390-$450; limited to 2 per year Hearing exam: $25 per year; Hearing aid: HMO: $0 exam, $250 max. per ear per 12 mos. Discounts avail. Mental health per visit, indiv./group $30 HMO/PPO: $25 in network; PPO: $50 out Basic: $30/$15; $20/$10 $25, $40 out Prime: $40; 30% out-of-network; Choice: $30/20% out; Extra: $20 $30; $35; Classic: $40; Enhanced: $25 All plans: $40/$30 ; PPO: $45/$35 out $40/$40; $30/$30 $25 $40 Members 11,700 65, , ,900 47,800 66, ,085 3, ,800+ Other details $0 lab tests; $0 diabetic testing supplies; 24-hour nurse advice line Routine chiro, acupuncture, naturopathy and/or SilverSneakers fitness program included on some plans; optional dental/vision buyups available. Jade Special Needs Plan available. Advantage Plus: Dental, extra eyewear and hearing aid optional package for additional $43/month. No cost for gym membership and Silver&Fit fitness program; outside benefit. Chiropractic, hearing, vision hardware, naturopathic and acupuncture benefits available for add l premium of $10/month; 12-month travel benefit; free gym membership and home fitness kits through Silver&Fit Silver&Fit no-cost gym membership; $0 copay for online video visits with providers through Health express; Optional dental plans starting at $33.70/mo; 24-hour nurse advice line; Vision plan for Prime: $8.80 SilverSneakers; PPO plans offer preventive dental; HMO optional benefits (dental and hearing): $39/month; PPO comprehensive dental: $28/ month. *PPO max out-of-pocket are and combined. PPO cost shares are for. Call for details. $0 Tier 1&2 90-day preferred mail order Rx; Generics as low as $2 at select pharmacies; dental riders: $34-$37; Silver Sneakers: $15; HouseCalls visit: $0; 24-hour nursing hotline; PPO passport option. Call for details No deductible for $0 drug tier; $40 monthly credit for over-thecounter remedies for Select Rx; $40 monthly gym credit for and Select Rx; 24/7 nurse hotline Silver&Fit: $50 co-pay/year; 24-hour nurse hotline; optional preventive dental available for $28/ month SilverSneakers no-cost gym membership; up to $20/mo. over-the-counter drug benefit; 24-hr nurse hotline; diabetes monitoring supplies 0%; nutritional meal benefit. Discounts for hearing, vision, alternative health care. Phone TTY: or TTY: ; Website careoregon advantage.org healthnet.com/ kp.org/ modahealth.com/ providence healthplan.com/ regence.com/ aarp plans.com familycarehealth plans.org.pacific source.com humana.com Page 5 of 5