PARTCRX

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

Why We Like This Plan

  • has both Health and Drug Coverage
  • has been rated 5 stars by CMS

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors for Most Services
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$4,900 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$14.50
Monthly Health Plan Premium
$26.50

Benefits

Service
Cost
Ambulance
$225
Doctor's office visits
Primary Physician
$30 per visit
Specialist
$35 per visit
Durable medical equipment (wheelchairs, oxygen, etc.)
0-20% per item
Emergency care
$75 per visit (always covered)
Home health care
You pay nothing
Mental health care
$245 for days 1 through 6
$0 for days 7 through 90
Outpatient hospital
$0-250 per visit
Renal dialysis
You pay nothing
Inpatient hospital care
$275 for days 1 through 6
$0 for days 7 through 90
Skilled Nursing Facility (SNF)
$0 for days 1 through 20
$50 for days 21 through 100

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 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$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 Tier33% coinsurance33% coinsurance33% coinsurance

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
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
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld
Not Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

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

/
SHIN, SE JUNG
13305 NW CORNELL RD STE C
PORTLAND, OR 97229
BARICH, FRANK
15640 NW LAIDLAW RD
PORTLAND, OR 97229
GLUCK, LORI
15640 NW LAIDLAW RD
PORTLAND, OR 97229
JI, DONG
15640 NW LAIDLAW RD
PORTLAND, OR 97229
PENA, ANGELES
15220 NW LAIDLAW RD STE 100
PORTLAND, OR 97229
CARTER, DALE
12400 NW CORNELL RD
PORTLAND, OR 97229
CHEN, SAMUEL
13831 NW CORNELL RD STE C
PORTLAND, OR 97229
JEWETT, STILES
12400 NW CORNELL RD
PORTLAND, OR 97229
LOSLI, STEVE
3300 NW 185TH AVE
PORTLAND, OR 97229
CHING, GERALD
15455 NW GREENBRIER PKWY
BEAVERTON, OR 97006
TORKELSON, EDMUND
1960 NW 167TH PL
BEAVERTON, OR 97006
ORAHOOD, BRIAN
17200 NW CORRIDOR CT STE 108
BEAVERTON, OR 97006
DEMLOW, ANITA
1881 NW 185TH AVE
ALOHA, OR 97006
DENMAN, SUSAN
18345 SW ALEXANDER ST
ALOHA, OR 97006
WEILL, BEAU
15455 NW GREENBRIER PKWY
BEAVERTON, OR 97006
MOSHOFSKY, DEAN
15455 NW GREENBRIER PKWY
BEAVERTON, OR 97006
TROCHMANN, REBEKAH
15950 SW MILLIKAN WAY
BEAVERTON, OR 97006
D'SOUZA-KAMATH, REEWEN
15950 SW MILLIKAN WAY
BEAVERTON, OR 97006
MILLER, GERALD
1960 NW 167TH PLACE
BEAVERTON, OR 97006
MOORE, HEATHER
15455 NW GREENBRIER PKWY
BEAVERTON, OR 97006
NEWMAN, STEWART
15050 SW KOLL PKWY
BEAVERTON, OR 97006
CHITWOOD, BRYAN
15950 SW MILLIKAN WAY
BEAVERTON, OR 97006
AZHAR, EZRA
3415 SW 187TH AVE
BEAVERTON, OR 97006
BARR, IAN
15455 NW GREENBRIER PKWY
BEAVERTON, OR 97006
GEORGE, ROBERT
15050 SW KOLL PKWY
BEAVERTON, OR 97006
Details
SE JUNG 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

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