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 careoregon advantage.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 ProvidenceHealth Plan.com Regence BlueCross BlueShield 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/Wellness Education 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 aarpmedicare plans.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.