Kaiser Permanente Senior Advantage Basic (HMO)

Medicare Advantage Plan (Part C w/ RX)

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Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Kaiser Permanente
CMS Rating
Plan Type
HMO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage
  • This plan is available for 2015. see plan

Why We Like This Plan

  • has both Health and Drug Coverage
  • has been rated 5 stars by CMS
  • was the 3rd best selling plan in Wahkiakum in 2014

Plan Details

Costs and Other Important Information

Plan Year:
2014
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$4,900 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$39.00

Benefits

Service
In Network
Out of Network
Inpatient Hospital Care
Days 1-6: $275 copay per day. Days 7-90: $0 copay per day
Not Applicable
Inpatient Mental Health Care
Days 1-6: $245 copay per day. Days 7-90: $0 copay per day
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-10: $0 copay per day. Days 11-20: $25 copay per day. Days 21-100: $50 copay per day
Not Applicable
Home Health Care
$0
Not Applicable
Doctor Office Visits
$30 maximum per visit
Not Applicable
Outpatient Services
$250 maximum per visit
Not Applicable
Ambulance Services
$200 maximum
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Kidney Disease and Conditions
$0
Not Applicable
Specialist Office Visit
$35 maximum per visit
Not Applicable

Prescription Drug Coverage

Drugs Covered under Medicare Part B

General

$0 to $45 copay for Medicare Part B chemotherapy drugs and other Part B drugs.


Drugs Covered under Medicare Part D

General

This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at http://kp.org/seniorrx on the web.

Different out-of-pocket costs may apply for people who
  • have limited incomes,
  • live in long term care facilities, or
  • have access to Indian/Tribal/Urban (Indian Health Service) providers.


Your in-network prescription coverage may be limited to the plan's service area. This means that if you travel outside the service area, you may have to pay the full cost of your prescription. In certain emergencies, your drugs will be covered if you get them at an out-of-network-pharmacy although you may have to pay additional charges. Contact the plan for details.

Total yearly drug costs are the total drug costs paid by both you and a Part D plan.

Your provider must get prior authorization from Kaiser Permanente Senior Advantage Basic (HMO) for certain drugs.

You must go to certain pharmacies for a very limited number of drugs, due to special handling, provider coordination, or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website, formulary, printed materials, as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov.

If the actual cost of a drug is less than the normal cost-sharing amount for that drug, you will pay the actual cost, not the higher cost-sharing amount.

If you request a formulary exception for a drug and Kaiser Permanente Senior Advantage Basic (HMO) approves the exception, you will pay Tier 3: Preferred Brand cost sharing for that drug.

In-Network

$0 deductible.

Initial Coverage

You pay the following until total yearly drug costs reach $2,850:

Retail Pharmacy

Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

You can get drugs the following way(s):

Tier 1: Preferred Generic

  • $5 copay for a one-month (30-day) supply of drugs in this tier


  • $15 copay for a three-month (90-day) supply of drugs in this tier


  • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 2: Non-Preferred Generic

  • $10 copay for a one-month (30-day) supply of drugs in this tier


  • $30 copay for a three-month (90-day) supply of drugs in this tier


  • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 3: Preferred Brand

  • $45 copay for a one-month (30-day) supply of drugs in this tier


  • $135 copay for a three-month (90-day) supply of drugs in this tier


  • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 4: Non-Preferred Brand

  • $90 copay for a one-month (30-day) supply of drugs in this tier


  • $270 copay for a three-month (90-day) supply of drugs in this tier


  • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 5: Specialty Tier

  • 25% coinsurance for a one-month (30-day) supply of drugs in this tier


  • 25% coinsurance for a three-month (90-day) supply of drugs in this tier


Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

Tier 6: Vaccines

  • $0 copay for a one-month (30-day) supply of drugs in this tier


  • Long Term Care Pharmacy

    Long term care pharmacies must dispense brand name drugs in amounts less than a 14 days supply at a time. They may also dispense less than a month's supply of generic drugs at a time. Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

    You can get drugs the following way(s):

    Tier 1: Preferred Generic

    • $5 copay for a one-month (31-day) supply of drugs in this tier


    • Tier 2: Non-Preferred Generic

    • $10 copay for a one-month (31-day) supply of drugs in this tier


    • Tier 3: Preferred Brand

    • $45 copay for a one-month (31-day) supply of drugs in this tier


    • Tier 4: Non-Preferred Brand

    • $90 copay for a one-month (31-day) supply of drugs in this tier


    • Tier 5: Specialty Tier

    • 25% coinsurance for a one-month (31-day) supply of drugs in this tier


    • Tier 6: Vaccines

    • $0 copay for a one-month (31-day) supply of drugs in this tier



    Mail Order


    Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

    You can get drugs the following way(s):

    Tier 1: Preferred Generic

    • $5 copay for a one-month (30-day) supply of drugs in this tier


    • $10 copay for a three-month (90-day) supply of drugs in this tier


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 2: Non-Preferred Generic

    • $10 copay for a one-month (30-day) supply of drugs in this tier


    • $20 copay for a three-month (90-day) supply of drugs in this tier


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 3: Preferred Brand

    • $45 copay for a one-month (30-day) supply of drugs in this tier


    • $90 copay for a three-month (90-day) supply of drugs in this tier


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 4: Non-Preferred Brand

    • $90 copay for a one-month (30-day) supply of drugs in this tier


    • $180 copay for a three-month (90-day) supply of drugs in this tier


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 5: Specialty Tier

    • 25% coinsurance for a one-month (30-day) supply of drugs in this tier


    • 25% coinsurance for a three-month (90-day) supply of drugs in this tier


    Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Coverage Gap

    After your total yearly drug costs reach $2,850, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 47.5% for the plan's costs for brand drugs and 72% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4,550.

    Additional Coverage Gap

    The plan covers all formulary generics (100% of formulary generic drugs), few formulary brands (less than 10% of formulary brand drugs) through the coverage gap.

    The plan offers additional coverage in the gap for the following tiers. You pay the following:

    Retail Pharmacy

    Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

    Tier 1: Preferred Generic

    • $5 copay for a one-month (30-day) supply of all drugs covered within this tier


    • $15 copay for a three-month (90-day) supply of all drugs covered within this tier


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 2: Non-Preferred Generic

    • $10 copay for a one-month (30-day) supply of all drugs covered within this tier


    • $30 copay for a three-month (90-day) supply of all drugs covered within this tier


    Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 6: Vaccines

  • $0 copay for a one-month (30-day) supply of all drugs covered within this tier


  • Long Term Care Pharmacy

    Long term care pharmacies must dispense brand name drugs in amounts less than a 14 days supply at a time. They may also dispense less than a month's supply of generic drugs at a time. Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

    Tier 1: Preferred Generic

    • $5 copay for a one-month (31-day) supply of all drugs covered within this tier


    • Tier 2: Non-Preferred Generic

    • $10 copay for a one-month (31-day) supply of all drugs covered within this tier


    • Tier 6: Vaccines

    • $0 copay for a one-month (31-day) supply of all drugs covered within this tier



    Mail Order


    Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

    Tier 1: Preferred Generic

    • $5 copay for a one-month (30-day) supply of all drugs covered within this tier


    • $10 copay for a three-month (90-day) supply of all drugs covered within this tier


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 2: Non-Preferred Generic

    • $10 copay for a one-month (30-day) supply of all drugs covered within this tier


    • $20 copay for a three-month (90-day) supply of all drugs covered within this tier


    Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Catastrophic Coverage

    After your yearly out-of-pocket drug costs reach $4,550, you pay the following:

    Tier 1: Preferred Generic

    • $5 copay for drugs in this tier


    • Tier 2: Non-Preferred Generic

    • $5 copay for drugs in this tier


    • Tier 3: Preferred Brand

    • $15 copay for drugs in this tier


    • Tier 4: Non-Preferred Brand

    • $15 copay for drugs in this tier


    • Tier 5: Specialty Tier

    • $15 copay for drugs in this tier


    • Tier 6: Vaccines

    • $0 copay for drugs in this tier


    Out-of-Network

    Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Kaiser Permanente Senior Advantage Basic (HMO).

    You can get out-of-network drugs the following way:

    Out-of-Network Initial Coverage

    You will be reimbursed up to the plan's cost of the drug minus the following for drugs purchased out-of-network until total yearly drug costs reach $2,850:

    Out-of-Network Initial Coverage

    Tier 1: Preferred Generic

    • $5 copay for a one-month (30-day) supply of drugs in this tier


    • Tier 2: Non-Preferred Generic

    • $10 copay for a one-month (30-day) supply of drugs in this tier


    • Tier 3: Preferred Brand

    • $45 copay for a one-month (30-day) supply of drugs in this tier


    • Tier 4: Non-Preferred Brand

    • $90 copay for a one-month (30-day) supply of drugs in this tier


    • Tier 5: Specialty Tier

    • 25% coinsurance for a one-month (30-day) supply of drugs in this tier


    • Tier 6: Vaccines

    • $0 copay for a one-month (30-day) supply of drugs in this tier


    Out-of-Network Coverage Gap

    You will be reimbursed up to 28% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4,550. Please note that the plan allowable cost may be less than the out-of-network pharmacy price paid for your drug(s). You will be reimbursed up to 52.5% of the plan allowable cost for brand name drugs purchased out-of-network until your total yearly out-of-pocket drug costs reach $4,550. Please note that the plan allowable cost may be less than the out-of-network pharmacy price paid for your drug(s).

    Additional Out-of-Network Coverage Gap

    You will be reimbursed for these drugs purchased out-of-network up to the plan's cost of the drug minus the following:

    Tier 1: Preferred Generic

    • $5 copay for a one-month (30-day) supply of all drugs covered within this tier


    • Tier 2: Non-Preferred Generic

    • $10 copay for a one-month (30-day) supply of all drugs covered within this tier


    • Tier 6: Vaccines

    • $0 copay for a one-month (30-day) supply of all drugs covered within this tier


    Out-of-Network Catastrophic Coverage

    After your yearly out-of-pocket drug costs reach $4,550, you will be reimbursed for drugs purchased out-of-network up to the plan's cost of the drug minus the following:

    Tier 1: Preferred Generic

    • $5 copay for drugs in this tier


    • Tier 2: Non-Preferred Generic

    • $5 copay for drugs in this tier


    • Tier 3: Preferred Brand

    • $15 copay for drugs in this tier


    • Tier 4: Non-Preferred Brand

    • $15 copay for drugs in this tier


    • Tier 5: Specialty Tier

    • $15 copay for drugs in this tier


    • Tier 6: Vaccines

    • $0 copay for drugs in this tier



    Optional Supplemental Benefits

    Optional Supplemental Package #1 Premium and Other Important Information Dental Services Hearing Services Vision Services

    Premium and Other Important Information

    General

    Package: 1 - Advantage Plus:

    $39 monthly premium, in addition to your $39 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits:
    • Preventive Dental
    • Comprehensive Dental
    • Eyewear
    • Hearing Aids



    Dental Services

    General

    Plan offers additional supplemental comprehensive dental benefits.

    In-Network

    $0 copay for the following supplemental preventive dental benefits:

    • up to 2 oral exam(s) every year


    • up to 2 cleaning(s) every year


    • up to 2 fluoride treatment(s) every year


    • up to 2 dental x-ray(s) every year


    $1,250 plan coverage limit for supplemental dental benefits every year


    Hearing Services

    In-Network

    $0 copay for up to 2 supplemental hearing aid(s) every three years

    $1,000 plan coverage limit for supplemental hearing aids every three years.


    Vision Services

    In-Network

    $0 copay for

    • up to 1 pair(s) of eyeglasses (lenses and frames) every two years


    • up to 1 pair(s) of contact lenses every two years


    $175 plan coverage limit for supplemental eyewear every two years



    General

    Package: 1 - Advantage Plus:

    $39 monthly premium, in addition to your $39 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits:
    • Preventive Dental
    • Comprehensive Dental
    • Eyewear
    • Hearing Aids




    General

    Plan offers additional supplemental comprehensive dental benefits.

    In-Network

    $0 copay for the following supplemental preventive dental benefits:

    • up to 2 oral exam(s) every year


    • up to 2 cleaning(s) every year


    • up to 2 fluoride treatment(s) every year


    • up to 2 dental x-ray(s) every year


    $1,250 plan coverage limit for supplemental dental benefits every year



    In-Network

    $0 copay for up to 2 supplemental hearing aid(s) every three years

    $1,000 plan coverage limit for supplemental hearing aids every three years.



    In-Network

    $0 copay for

    • up to 1 pair(s) of eyeglasses (lenses and frames) every two years


    • up to 1 pair(s) of contact lenses every two years


    $175 plan coverage limit for supplemental eyewear every two years


    Premium and Other Important Information

    General

    Package: 1 - Advantage Plus:

    $39 monthly premium, in addition to your $39 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits:
    • Preventive Dental
    • Comprehensive Dental
    • Eyewear
    • Hearing Aids



    Dental Services

    General

    Plan offers additional supplemental comprehensive dental benefits.

    In-Network

    $0 copay for the following supplemental preventive dental benefits:

    • up to 2 oral exam(s) every year


    • up to 2 cleaning(s) every year


    • up to 2 fluoride treatment(s) every year


    • up to 2 dental x-ray(s) every year


    $1,250 plan coverage limit for supplemental dental benefits every year


    Hearing Services

    In-Network

    $0 copay for up to 2 supplemental hearing aid(s) every three years

    $1,000 plan coverage limit for supplemental hearing aids every three years.


    Vision Services

    In-Network

    $0 copay for

    • up to 1 pair(s) of eyeglasses (lenses and frames) every two years


    • up to 1 pair(s) of contact lenses every two years


    $175 plan coverage limit for supplemental eyewear every two years


    Other Services

    Inpatient Care

    Doctor and Hospital Choice



    In-Network

    You must go to network doctors, specialists, and hospitals.

    Referral required for network hospitals and specialists (for certain benefits).


    ,

    Inpatient Hospital Care



    In-Network

    No limit to the number of days covered by the plan each hospital stay.

    For Medicare-covered hospital stays:

    • Days 1 - 6: $275 copay per day


    • Days 7 - 90: $0 copay per day


    $0 copay for additional non-Medicare-covered hospital days

    Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.


    Outpatient Care

    Inpatient Mental Health Care



    In-Network

    You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.

    For Medicare-covered hospital stays:

    • Days 1 - 6: $245 copay per day


    • Days 7 - 90: $0 copay per day


    Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.

    Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.


    ,

    Skilled Nursing Facility (SNF)



    General

    Authorization rules may apply.

    In-Network

    Plan covers up to 100 days each benefit period

    No prior hospital stay is required.

    For SNF stays:

    • Days 1 - 10: $0 copay per day


    • Days 11 - 20: $25 copay per day


    • Days 21 - 100: $50 copay per day



    ,

    Home Health Care



    General

    Authorization rules may apply.

    In-Network

    $0 copay for Medicare-covered home health visits


    ,

    Hospice



    General

    You must get care from a Medicare-certified hospice. You must consult with your plan before you select hospice.


    ,

    Doctor Office Visits



    General

    Authorization rules may apply.

    In-Network

    $30 copay for each Medicare-covered primary care doctor visit.

    $35 copay for each Medicare-covered specialist visit.


    Outpatient Medical Services and Supplies

    Chiropractic Services



    General

    Authorization rules may apply.

    In-Network

    $20 copay for each Medicare-covered chiropractic visit

    Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part).


    ,

    Podiatry Services



    General

    Authorization rules may apply.

    In-Network

    $35 copay for each Medicare-covered podiatry visit

    Medicare-covered podiatry visits are for medically necessary foot care.


    ,

    Outpatient Mental Health Care



    General

    Authorization rules may apply.

    In-Network

    $30 copay for each Medicare-covered individual therapy visit

    $15 copay for each Medicare-covered group therapy visit

    $30 copay for each Medicare-covered individual therapy visit with a psychiatrist

    $15 copay for each Medicare-covered group therapy visit with a psychiatrist

    $30 copay for Medicare-covered partial hospitalization program services


    ,

    Outpatient Substance Abuse Care



    General

    Authorization rules may apply.

    In-Network

    $30 copay for Medicare-covered individual substance abuse outpatient treatment visits

    $15 copay for Medicare-covered group substance abuse outpatient treatment visits


    ,

    Outpatient Services



    General

    Authorization rules may apply.

    In-Network

    $250 copay for each Medicare-covered ambulatory surgical center visit

    $0 to $250 copay for each Medicare-covered outpatient hospital facility visit


    ,

    Ambulance Services



    General

    Authorization rules may apply.

    In-Network

    $200 copay for Medicare-covered ambulance benefits.


    ,

    Emergency Care



    General

    $65 copay for Medicare-covered emergency room visits

    Worldwide coverage.

    If you are immediately admitted to the hospital, you pay $0 for the emergency room visit.


    ,

    Urgently Needed Care



    General

    $35 copay for Medicare-covered urgently-needed-care visits


    ,

    Outpatient Rehabilitation Services



    General

    Authorization rules may apply.

    Medically necessary physical therapy, occupational therapy, and speech and language pathology services are covered.

    In-Network

    $35 copay for Medicare-covered Occupational Therapy visits

    $35 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits


    ,

    Durable Medical Equipment



    General

    Authorization rules may apply.

    In-Network

    0% to 20% of the cost for Medicare-covered durable medical equipment


    Preventive Services

    Prosthetic Devices



    General

    Authorization rules may apply.

    In-Network

    20% of the cost for Medicare-covered prosthetic devices

    0% to 20% of the cost for Medicare-covered medical supplies related to prosthetics, splints, and other devices


    ,

    Diabetes Programs and Supplies



    General

    Authorization rules may apply.

    In-Network

    $0 copay for Medicare-covered Diabetes self-management training

    0% of the cost for Medicare-covered Diabetes monitoring supplies

    20% of the cost for Medicare-covered Therapeutic shoes or inserts

    If the doctor provides you services in addition to Diabetes self-management training, separate cost sharing of $30 to $35 may apply


    ,

    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services



    General

    Authorization rules may apply.

    In-Network

    $0 copay for Medicare-covered lab services

    $0 copay for Medicare-covered diagnostic procedures and tests

    $15 copay for Medicare-covered X-rays

    $175 copay for Medicare-covered diagnostic radiology services (not including X-rays)

    $35 copay for Medicare-covered therapeutic radiology services

    If the doctor provides you services in addition to Outpatient Diagnostic Procedures, Tests and Lab Services, separate cost sharing of $30 to $35 may apply

    If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services, separate cost sharing of $30 to $35 may apply


    ,

    Cardiac and Pulmonary Rehabilitation Services



    General

    Authorization rules may apply.

    In-Network

    $35 copay for Medicare-covered Cardiac Rehabilitation Services

    $35 copay for Medicare-covered Intensive Cardiac Rehabilitation Services

    $35 copay for Medicare-covered Pulmonary Rehabilitation Services


    Additional Benefits

    Preventive Services



    General

    $0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.

    In-Network

    $0 copay for a supplemental annual physical exam


    ,

    Kidney Disease and Conditions



    General

    Authorization rules may apply.

    In-Network

    $0 copay for Medicare-covered renal dialysis

    $0 copay for Medicare-covered kidney disease education services


    ,

    Dental Services



    In-Network

    This plan covers some preventive dental benefits for an extra cost (see "Optional Supplemental Benefits.")

    $0 copay for Medicare-covered dental benefits


    ,

    Hearing Services



    In-Network

    $35 copay for Medicare-covered diagnostic hearing exams

    $35 copay for supplemental routine hearing exams


    ,

    Vision Services



    In-Network

    $35 copay for Medicare-covered exams to diagnose and treat diseases and conditions of the eye, including an annual glaucoma screening for people at risk

    $35 copay for supplemental routine eye exams

    $0 copay for
    • one pair of Medicare-covered eyeglasses (lenses and frames) or contact lenses after cataract surgery



    Cost Sharing Information

    Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

    30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
    Tier 1: Preferred Generic$5 copay$5 copay$5 copay
    Tier 2: Non-Preferred Generic$10 copay$10 copay$10 copay
    Tier 3: Preferred Brand Name$45 copay$45 copay$45 copay
    Tier 4: Non-Preferred Brand Name$90 copay$90 copay$90 copay
    Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance
    90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
    Tier 1: Preferred Generic$15 copay$15 copay$10 copay
    Tier 2: Non-Preferred Generic$30 copay$30 copay$20 copay
    Tier 3: Preferred Brand Name$135 copay$135 copay$90 copay
    Tier 4: Non-Preferred Brand Name$270 copay$270 copay$180 copay
    Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance

    CMS Ratings

    Staying healthy - screenings, tests and vaccines

    Breast cancer screening
    Not Rated
    Colorectal cancer screening
    Cholesterol screening for patients with heart disease
    Glaucoma testing
    Annual flu vaccine
    Pneumonia vaccine
    Improving or maintaining physical health
    Improving or maintaining mental health
    Monitoring physical ability
    Access to primary care doctor visits
    Adult BMI assessment

    Managing Chronic Conditions

    Care for older adults – medication review
    Not Rated
    Care for older adults – functional status assessment
    Not Rated
    Care for older adults – Pain screening
    Not Rated
    Osteoporosis management in women who had a fracture
    Diabetes care – eye exam
    Diabetes care – kidney disease monitoring
    Diabetes care – blood sugar controlled
    Diabetes care – cholesterol controlled
    Controlling blood pressure
    Rheumatoid arthritis management
    Improving bladder control
    Reducing the risk of falling
    Plan all-cause readmissions

    Ratings of Plan Responsiveness and Care

    Getting needed care
    Getting appointments and care quickly
    Customer service
    Overall rating of health care quality
    Overall rating of plan

    Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

    Complaints about the health plan
    Beneficiary access and performance problems
    Members choosing to leave the plan
    Plan makes timely decision about appeals
    Reviewing appeals decisions
    Call center – foreign language interpreter and TTY/TDD availability

    Physician Finder

    Physicians that accept Kaiser Permanente Senior Advantage Basic (HMO) for Oregon

    /
    SHIN, SEJUNG
    13305 NW CORNELL RD STE C
    PORTLAND, OR 97229
    LOSLI, STEVE
    3300 NW 185TH AVE
    PORTLAND, OR 97229
    JEWETT, STILES
    12400 NW CORNELL RD
    PORTLAND, OR 97229
    CARTER, DALE
    12400 NW CORNELL RD
    PORTLAND, OR 97229
    FLATH, LAURA
    13580 NW PETTYGROVE ST
    PORTLAND, OR 97229
    MOSHOFSKY, DEAN
    15455 NW GREENBRIER PKWY
    BEAVERTON, OR 97006
    CHING, GERALD
    15455 NW GREENBRIER PKWY
    BEAVERTON, OR 97006
    NEACE, GWYNNETH
    15455 NW GREENBRIER PKWY
    BEAVERTON, OR 97006
    MOORE, HEATHER
    15455 NW GREENBRIER PKWY
    BEAVERTON, OR 97006
    DENMAN, SUSAN
    18345 SW ALEXANDER ST
    ALOHA, OR 97006
    DEMLOW, ANITA
    1881 NW 185TH AVE
    ALOHA, OR 97006
    MILLER, GERALD
    1960 NW 167TH PLACE
    BEAVERTON, OR 97006
    ORAHOOD, BRIAN
    17200 NW CORRIDOR CT STE 108
    BEAVERTON, OR 97006
    TORKELSON, EDMUND
    1960 NW 167TH PL
    BEAVERTON, OR 97006
    HARRIS, KAREN
    200 S HAZEL DELL WAY
    CANBY, OR 97013
    GEORGE, ROBERT
    15050 SW KOLL PKWY
    BEAVERTON, OR 97006
    NEWMAN, STEWART
    15050 SW KOLL PKWY
    BEAVERTON, OR 97006
    EVANS, CODY
    1400 NW MARSHALL ST
    PORTLAND, OR 97209
    HILL, CHRISTIAN
    2935 SW CEDAR HILLS BLVD
    BEAVERTON, OR 97005
    PENG, LOUIS
    18610 NW CORNELL RD
    HILLSBORO, OR 97124
    GUEORDJEVA, PETYA
    2935 SW CEDAR HILLS BLVD
    BEAVERTON, OR 97005
    SCHUSTER, ERICKA
    4855 SW WESTERN AVE
    BEAVERTON, OR 97005
    SCHWARTZ, MARTIN
    4855 SW WESTERN AVE
    BEAVERTON, OR 97005
    DUNLAP, SCOTT
    4855 SW WESTERN AVE
    BEAVERTON, OR 97005
    HELMS, DEBORAH
    4855 SW WESTERN AVE
    BEAVERTON, OR 97005
    Details
    SEJUNG SHIN, M.D.
    Phone Number
    (503) 646-8500
    Office Locations
    13305 NW CORNELL RD STE C
    PORTLAND, OR 97229
    13305 NW CORNELL RD STE C PORTLAND OR, 97229

    Community Q&A

    Do you have questions about this plan?

    Get answers from the HealthPocket community.
    1 question| 1 answer
    About this Medicare Advantage Plan
    Q:I am interested in finding out if this plan is good. What is the cost for a visit to a Primary Care Physician (PCP)? The premium is $39.00, how and when is this paid? Are the generic prescription relatively inexpensive, and what participating pharmacies are involved in the Alpharetta/Roswell, GA areas. Finally how would I go about enrolling in this plan? Thanks.
    Asked by Anonymous 

    1 answer

    Know the Answer? Answer this Question
    A: From the Plan Details page, it reads: Doctor Office Visits In Network: $30 maximum per visit . You may check the Plan Details page for prescription benefits. As for the monthly premium, normally you will need to submit the payment information once you fill out the application. Hit the Continue Online button, then you will be able to get the apply methods. You may try the following link for the participating pharmacies: https://healthy.kaiserpermanente.org/health/care/consumer/locate-our-services/doctors-and-locations?redirected_from=https://members.kaiserpermanente.org/kpweb/facilitydir/entrypage.do If you have other questions, you may speak with a licensed agent. The phone number and hours of operation is available when you click on 'Select'.
    Answered on 1/25/2014 by davina

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