PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Regence BlueCross BlueShield of Oregon
CMS Rating
Plan Type
PPO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2014
Optional Supplemental Benefits?
No
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$2,500 In-Network$2,500 In and Out-of-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$56.10
Monthly Health Plan Premium
$86.90

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$15 maximum per visit
$25 maximum per visit
Specialist Office Visit
$25 maximum per visit
$25 maximum per visit
Outpatient Services
$100 maximum per visit
$200 maximum per visit
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$100 maximum
$100 maximum
Kidney Disease and Conditions
10% maximum per visit
10% maximum per visit
Home Health Care
$0
10% maximum per visit
Durable Medical Equipment
10% maximum per item
20% maximum per item
Inpatient Hospital Care
Days 1-7: $150 copay per day. Days 8-90: $0 copay per day
Days 1-7: $250 copay per day. Days 8 and beyond: $0 copay per day
Skilled Nursing Facility (SNF)
Days 1-20: $40 copay per day. Days 21-100: $0 copay per day
Days 1-20: $60 copay per SNF day. Days 21-100: $0 copay per SNF day
Inpatient Mental Health Care
Days 1-7: $150 copay per day. Days 8-90: $0 copay per day
Days 1-7: $250 copay per day. Days 8-190: $0 copay per day

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$33 copay$33 copay$33 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 Tier33% coinsurance33% coinsurance33% 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$99 copay$99 copay$66 copay
Tier 3: Preferred Brand Name$135 copay$135 copay$112.5 copay
Tier 4: Non-Preferred Brand Name$270 copay$270 copay$225 copay
Tier 5: Specialty Tier

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 Regence MedAdvantage + Rx Enhanced (PPO) for Oregon

/
MATIN, LAURA
14740 NW CORNELL RD
PORTLAND, OR 97229
GRAHAM, BARBARA
12672 NW BARNES RD
PORTLAND, OR 97229
SHIN, SEJUNG
13305 NW CORNELL RD STE C
PORTLAND, OR 97229
HARDEBECK, LAURA
13520 NW PETTYGROVE ST
PORTLAND, OR 97229
LUTFI, EMAN
9555 SW BARNES RD
PORTLAND, OR 97229
HANKENSON, LORI
9555 SW BARNES RD
PORTLAND, OR 97229
CRIHFIELD, KIMBERLY
15285 NW CENTRAL DR
PORTLAND, OR 97229
LOSLI, STEVE
3300 NW 185TH AVE
PORTLAND, OR 97229
KRISCIUNAS, VIC
12400 NW CORNELL RD
PORTLAND, OR 97229
GEDDES, GARY
12400 NW CORNELL RD
PORTLAND, OR 97229
DOSHI, HEENA
12400 NW CORNELL RD
PORTLAND, OR 97229
BARLOW, ROBERT
12400 NW CORNELL RD
PORTLAND, OR 97229
WILSON, ADDISON
15285 NW CENTRAL DR
PORTLAND, OR 97229
RADHAKRISHNAN, LATHA
13661 NW STONEBRIDGE DR
PORTLAND, OR 97229
JEWETT, STILES
12400 NW CORNELL RD
PORTLAND, OR 97229
CARTER, DALE
12400 NW CORNELL RD
PORTLAND, OR 97229
ROMERO, CYNTHIA
14600 NW CORNELL RD
PORTLAND, OR 97229
BLIEVERNICHT, MATTHEW
15280 NW CENTRAL DR
PORTLAND, OR 97229
FLATH, LAURA
13580 NW PETTYGROVE ST
PORTLAND, OR 97229
SAMAGH, GUNJEET
15640 NW LAIDLAW RD
PORTLAND, OR 97229
BARRY, HAROLD
12400 NW CORNELL RD
PORTLAND, OR 97229
PASKOWSKI, BRIAN
15285 NW CENTRAL DR
PORTLAND, OR 97229
KO, ALMIRA
4608 NW 166TH AVE
PORTLAND, OR 97229
TOBIN, TERRY
660 NW MURRAY BLVD
PORTLAND, OR 97229
MOSHOFSKY, DEAN
15455 NW GREENBRIER PKWY
BEAVERTON, OR 97006
Details
LAURA MATIN, DDS
Phone Number
(503) 690-0400
Office Locations
14740 NW CORNELL RD
PORTLAND, OR 97229
14740 NW CORNELL RD PORTLAND OR, 97229

Community Q&A

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1 question
Medicare plans informational meetings in Portland area
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