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SUNDAY MASTHED

SECTION FLAG

DAILY MASTHED

Monthly premium 2012/2013

Doctors and other providers in-network

Choice of hospitals

County service areas

Health/Drug Plan Quality Rating (out of 5 stars)

Plan deductible

Hospital charges

Doctor charges, per visit

Maximum out-of-pocket

Emergency care co-pay, U.S./foreign

Drug co-pays, deductible. This year, in the gap, you'll pay 47.5% of cost of select brand name drugs & 79% of generics.

Ambulance co-pay

Routine eye exams/eyeglasses

Skilled nursing co-pay (no coverage after 100 days)

Routine hearing exams/hearing aids

Mental health per visit

Members

Other details

Telephone

Web site

CareOregon Inc.

Advantage Star $36.40/$37.50

4,000

Adventist, Legacy, Tuality, OHSU and Willamette Falls hospitals in metro area; others through-out service area

Clackamas, Clatsop, Multnomah, Washing-ton, Columbia, Jackson, Josephine, Marion and Polk

$0

$300/day first 5 days, then full coverage

$10 primary/$30 specialist

$6,700

$65 nationwide

Generic $5; brand 25%; deductible $325 for brand-name drugs only

$200

$20 exams; $0 lenses every 2 years plus up to $75 toward frames every 2 years

Days 1-20: $0; days 21-100: $100

Not covered/not covered

$30

8,400

24-hour nurse line; $0 lab tests

800-224-4840; TTY: 1-877-416-4161

careoregonadvantage.org

Health Net

Ruby HMO: $59/$23;Jade HMO SNP: NA/$0; Healthy Heart PPO: $149/$159;Violet Option 1 PPO: $99/$99; Violet Option 2 PPO: $0/$0

More than 6,500

Adventist, Legacy, Tuality and Peace-Health Southwest in metro area; others throughout service area

HMO: Clackamas, Marion, Multnomah, Polk, Washington and Yamhill. PPO: Benton, Clackamas, Columbia, Hood River, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill and Clark (Wash.); variations available in Douglas, Jackson and Josephine

Violet Plan 2:Ruby: Too new to rate

Ruby: $0; Jade: $335; Healthy Heart: $145; Violet Option 1 & 2: $225/$345

Ruby: $200/day first 8 days, then full cover- age; Jade: $250/day first 6 days, then full coverage; Healthy Heart: $175/day first 6 days, then full cover- age; Violet Option 1: $200/day first 7 days, then full coverage;Violet Option 2: $250/day first 7 days, then full coverage

Ruby: $8 primary/$20 specialist;Jade: $0/$20; Healthy Heart: $10;Violet Option 1: $12;Violet Option 2 : $15

Ruby: $2,250; Jade: $3,000; Healthy Heart: $2,000/$3,500 in-network/combined;Violet Option 1: $2,500/$4,000;Violet Option 2: $3,400/$4,500

$65 worldwide, waived if admitted

Ruby and Jade: prefer generic $0; non-prefer generic $20; prefer brand $38; non-prefer brand $95; Healthy Heart: prefer generic $3; non-prefer generic $10; prefer brand $35; non-prefer brand $95;Violet Option 1 / Option 2: prefer generic $3/$3; non-prefer generic $15/$20; prefer brand $42/$45; non-prefer brand $95/ $95; All: discounted prefer mail order; no deductible

Ruby: $125; Jade: $175;Healthy Heart: $150;Violet 1 & 2: $175/$250

Ruby, Jade, Healthy Heart, Violet Option 1: $10 exam; $100 eye- wear allowance every 2 years; Violet Option 2: buy-up available

Days 1-20, all plans: $0; days 21-100, Ruby: $100; Jade: $100; Healthy Heart: $75; Violet Option 1: $100; Violet Option 2: $100

Hearing exam same as specialist visit; Healthy Heart: $250 hearing aid allowance every 3 years

$25

44,600

Integrated routine chiropractic, acupunc-ture, naturopathy, $15 per visit; Silver&Fit health club member-ship for all but Violet Option 2; preventive dental for Healthy Heart; Aqua MA-only plan available; optional extended dental/vision buy-ups

800-822-7698; TTY: 1-800-929-9955

www.healthnet.com

Kaiser Permanente

Senior Advantage Basic HMO: $39/$39; Senior Advantage HMO: $99/$99

More than 3,500

Kaiser Sunnyside, Providence St. Vin- cent, Salem, Peace-Health Southwest and new Westside Medical Center opening August 2013

Clackamas, Columbia, Marion, Multnomah, Polk, Washington, Yamhill, and parts of Benton and Linn; Clark, Cowlitz, and parts of Lewis and Wahkiakum in Washington

$0

Basic: $275/day first 6 days, then full coverage; Senior Advantage: $200/day first 6 days, then full coverage

Basic: $30 primary/ $35 specialist; Senior Advantage: $20/$25

Basic: $3,400; Senior Advantage: $2,500

Basic: $65 worldwide; Senior Advantage: $50

Prefer generic $6; nonprefer generic $10; prefer brand $45; nonprefer brand $65; specialty drugs 25%; vaccines $0; gap coverage: $6/$10 for prefer/non-prefer generic; mail-order discounts; no deductible

Basic: $150; Senior Advantage: $100

Basic: $35 exams; Senior Advantage: $25; see optional package below for eyewear

Basic: days 1-10, $0; days 11-100, $50; Senior Advantage: days 1-100, $0

Basic: $35 exams; Senior Advantage: $25 exams; see optional package for hearing aids

Basic: $30/$15 group; Senior Advantage: $20/$10 group

36,700

Advantage Plus: dental, extra eyewear and hearing aid optional package for $39/month; Senior Advantage: No cost for gym membership and Silver&Fit fitness program; travel benefit

855-827-5609; 877-221-8221 existing members; TTY: 711

kp.org/medicare

Providence Health Plans

Medicare Choice+Rx: $76/$52;Medicare Extra+Rx: $130/$133;Medicare Open+Rx: $155/$188

More than 9,600

Providence and many community hospitals, including Tuality, Salem, Silverton, Cottage Grove, Willamette Valley and PeaceHealth Southwest

Clackamas, Marion, Multnomah, Polk, Washington, Yamhill, Clark (Wash.); Extra & Choice also available in Columbia, Lane and Snohomish (Wash.)

Choice & Extra:

Open: Not enough info

$0

Choice: $225/day first 6 days, then full coverage; out-of-network 20%; Extra: $125/day first 6 days, then full coverage. Open: $150/day first 6 days, then full coverage; out-of-network $200/day first 6 days, then full coverage

Choice: $20/$30 in/out-of-network; Extra: $15; Open: $10/$25

Choice: $3,000;Extra and Open: $2,500

$65 worldwide, waived if admitted within 24 hours

Prefer generic/prefer pharmacy $6; prefer generic/non-prefer pharmacy $9;non-prefer generic/ prefer pharmacy $11;non-prefer generic/ non-prefer pharmacy $15; prefer brand $35; non-prefer brand $70; specialty drugs 33%; no deductible

Choice: $150;Extra and Open: $100

Choice: $20 exams; $30 out-of-network;Extra: $15 exams;Open: $10 exams; $25 out-of-network; All: Eyewear discounts

Choice: days 1-10, $0; days 11-100, $50; 20% out-of-network; Extra: days 1-20, $0; days 21-100, $50;Open: days 1-10, $0; days 11-100, $50 in- or out-of-network

Not covered/hearing aid discounts available

Choice: $20; 20% out-of-network;Extra: $15; Open: $10; $25 out-of-network

40,900

Silver Sneakers free gym membership; 24-hour nurse advice line; discounts for alternative health care, acupuncture, massage, therapy, LifeBalance, recreational and cutural events; MA-only plans available

503-574-5551; 800-457-6064; TTY: 711

ProvidenceHealthPlan.com

Regence BlueCrossBlueShield of Oregon

MedAdvantage+Rx Classic: $67/$53; MedAdvantage+Rx Enhanced: $135/$143

More than 10,000

39 hospitals in Oregon

Benton, Clackamas,Clatsop, Columbia, Coos, Curry, Douglas, Hood River, Jackson, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington, Yamhill and Clark (Wash.)

Enhanced: $0; Classic: $50

$200/day in-network and $300/day out-of-network first 7 days, then full coverage

Classic: $15 primary/ $35 specialist; Enhanced: $15/$25

Classic: $3,400; Enhanced: $2,500

$65, waived if admitted within 48 hours

Classic: generic $7.50-$33; brand $45 or $90; specialty drugs: 29%; deduct-ible $165; Enhanced: generic: $5-$33;brand: $45 or $90;specialty drugs: 33%; no deductible

$100

Classic: $35 co-pay exam; $100/year for eyewear; Enhanced: $25 co-pay $200/year for eyewear; deductible does not apply

In-network: days 1-20, $40/day; days 21-100, $80/day ($0/day for Enhanced); Out-of-network: days 1-20, $60/day; days 21-100, $100/day ($0/day for Enhanced)

Classic: $15-$35 exams; out-of-network $35; Enhanced: $15-$25; out-of-network $25; Hearing-aid discount

Classic: $15-$35; Enhanced: $15-$25

49,400

$500 preventive dental benefit;SilverSneakers/Health/WellnessEducation

800-541-8981; 888-734-3623 nonmembers; TTY: 711

regence.com/medicare

ODS Health Plan Inc.

Advantage PPO+Rx NA/ $68; Advantage PPO+Rx Select: $128.30/$139

More than 6,500

OHSU, St. Charles, Providence system, Legacy and most major independents; outside the network, any hospital that accepts Medicare

All of Oregon

$150; Select: $50

In-network: $295/day first 5 days, then full coverage; Select: $250/day first 5 days, then full coverage. Out-of-network: $400/day first 5 days, then full coverage; Select: $350/day first 5 days, then full coverage

$25 primary/$50 specialist; Select: $20/$35

$3,400

$65 worldwide, waived if admitted

Both plans: prefer generic $5; non- prefer generic $33; prefer brand $41; non-prefer brand 50%; specialty drugs 30%; deductible $120

$250; Select: $100

Not covered; Select: $35 every 2 years; eyewear available with Extra Care buy-up

Days 1-20, $0; days 21-100, $100; Select: days 1-10, $0; days 11-100, $50

Available with Extra Care buy-up

$30/$20 for group

7,800

12-month travel/visitor benefit; chiropractic, hearing, vision, naturopathic and acupuncture benefits available for additional premium; MA-only plan available

888-217-2375 TTY: 711

odscompanies.com/odsadvantage

UnitedHealthcare

AARP MedicareCom-plete Plan 1 HMO: $65/$55; AARP MedicareCom-plete Plan 2 HMO: NA/$0; AARP MedicareCom-plete Choice PPO: $0/$0

More than 7,500

HMO Plan 1 & 2: 30 hospitals in-network including Adventist, Legacy, Providence and Tuality; PPO: 13 hospitals in-network including Adventist, Legacy, Tuality and Willamette Valley

PPO: Clackamas, Lane, Marion, Multnomah, Washington and Yamhill; HMOs: Clackamas, Marion, Multnomah, Polk and Washington; other plans available in Benton, Linn and Lane, as well as Clark and Cowlitz in Washington

HMO Plans 1 & 2:

PPO:

$0

HMO Plan 1: $250/day first 7 days, then full coverage; HMO Plan 2: $265/day first 6 days, then full coverage; PPO: $295/day first 5 days, then full coverage

HMO Plan 1: $10; HMO Plan 2: $15; PPO: $15

HMO Plan 1: $3,500; HMO Plan 2: $3,900; PPO: $4,500 in-network

All Plans: $65 worldwide

HMO Plan 1 & Plan 2: prefer generic $3/$4; non-prefer generic $6/$7; prefer brand $44/$45; nonprefer brand $88/$95; specialty drugs 33%/ 33%; no deductible PPO: prefer generic $3; nonprefer generic $6; prefer brand $45; nonprefer brand $95; specialty 33%; no deductible

$200

HMO Plan 1 & 2: $0-$20 exam; $30 co-pay eyewear (up to $70 every 2 years); PPO: $0-$30 in-network/$45 out-of-network exam

HMO Plan 1: days 1-20, $50; days 21-54, $75; days 55-100, $0; HMO Plan 2: days 1-20, $50; days 21-40, $150; days 41-100, $0; PPO: days 1-20, $50; days 21-40, $150; days 41-100, $0

HMO Plan 1/Plan 2/PPO: $20/$15/$30 in-network; hearing aids $340-$390

$40 individual in-network

34,850

Generics as low as $2 at select pharmacies; dental riders: $15/$29

800-547-5514

aarpmedicareplans.com

PAM MARTIN/THE OREGONIAN

Medicare managed care plans with drug coverage offered by seven insurers with the largest Medicare Advantage enrollment in Oregon

Sources: Oregon Senior Health Insurance Benefits Assistance program; insurers; www.medicare.gov; Oregon Insurance Division.