Kaiser Permanente Senior Advantage (HMO)

Medicare Advantage Plan for Oregon

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderKaiser Permanente
Plan IDH9003-1-0
CMS Rating1
Plan TypeHMO
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

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$2,500 In-network
Other health plan deductibles?
Yes
Health Plan Deductible
$0
Monthly Drug Plan Premium
$68.40
Monthly Health Plan Premium
$58.60

Benefits

Service
Cost
Inpatient hospital coverage
$200 for days 1 through 6
$0 for days 7 through 90
Outpatient hospital coverage
$0-135 per visit
Doctor visits
Primary:
$15 per visit
Specialist:
$25 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$75 per visit (always covered)
Urgent care:
$25 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
$10-25
Lab services:
$0 copay
Diagnostic radiology services (e.g., MRI):
$10-100
Outpatient x-rays:
$10
Mental health services
$200 for days 1 through 6
$0 for days 7 through 90
Outpatient group therapy visit with a psychiatrist:
$7
Outpatient individual therapy visit with a psychiatrist:
$15
Outpatient group therapy visit:
$7
Outpatient individual therapy visit:
$15
Skilled Nursing Facility
$0 copay
Rehabilitation services
Occupational therapy visit:
$25
Physical therapy and speech and language therapy visit:
$25
Ambulance
$150
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$25
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
0-20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
$10-45 or 0-15%
Other Part B drugs:
$0-45 or 0-15%

Coverage Area for Kaiser Permanente Senior Advantage (HMO)

StateOregon
CountyMultnomah

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds$5 copayNot offered
Tier 2: Non-Preferred GenericNot offered$10 copayNot offered
Tier 3: Preferred Brand NameNot offered$45 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$90 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$15 copayNot offered
Tier 2: Non-Preferred GenericNot offered$30 copayNot offered
Tier 3: Preferred Brand NameNot offered$135 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$270 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered

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

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Not Rated
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 (HMO) for Oregon

/
BARICH, FRANK
15640 NW LAIDLAW RD
PORTLAND, OR 97229
GLUCK, LORI
15640 NW LAIDLAW RD
PORTLAND, OR 97229
LOWENSTEIN, KEITH
15160 NW LAID LAW RD
PORTLAND, OR 97229
JI, DONG
15640 NW LAIDLAW RD
PORTLAND, OR 97229
PENA, ANGELES
15220 NW LAIDLAW RD STE 100
PORTLAND, OR 97229
MCILRAITH, MARLO
15220 NW LAIDLAW RD STE 100
PORTLAND, OR 97229
JEWETT, STILES
12400 NW CORNELL RD
PORTLAND, OR 97229
LOSLI, STEVE
3300 NW 185TH AVE
PORTLAND, OR 97229
SHIN, SE JUNG
13305 NW CORNELL RD STE C
PORTLAND, OR 97229
KIM, GARY
15950 SW MILLIKAN WAY
BEAVERTON, OR 97006
D'SOUZA-KAMATH, REEWEN
15950 SW MILLIKAN WAY
BEAVERTON, OR 97006
BARR, IAN
15455 NW GREENBRIER PKWY
BEAVERTON, OR 97006
MIRTORABI, MEHDI
2155 NW 173RD AVE
BEAVERTON, OR 97006
ROHRBACK, JANELLE
15950 SW MILLIKAN WAY
BEAVERTON, OR 97006
ULMER, MARY
15950 SW MILLIKAN WAY
BEAVERTON, OR 97006
YEE, KEVIN
15700 SW GREYSTONE COURT
BEAVERTON, OR 97006
PALM, KATHLEEN
15950 SW MILLIKAN WAY
BEAVERTON, OR 97006
HORRALL, MARY
15950 SW MILLIKAN WAY
BEAVERTON, OR 97006
CAMARA, JOCELYN
1960 NW 167TH PL., SUITE 205
BEAVERTON, OR 97006
GRIFFITH, LUCINDA
15950 SW MILLIKAN WAY
BEAVERTON, OR 97006
ORAHOOD, BRIAN
17200 NW CORRIDOR CT STE 108
BEAVERTON, OR 97006
SUK, SAMUEL
1500 NW BETHANY BLVD STE 200
BEAVERTON, OR 97006
GEORGE, ROBERT
15050 SW KOLL PKWY
BEAVERTON, OR 97006
DENMAN, SUSAN
18345 SW ALEXANDER ST
ALOHA, OR 97006
Details
FRANK BARICH, MD PHD
Phone Number
(503) 764-0100
Office Locations
15640 NW LAIDLAW RD
PORTLAND, OR 97229
15640 NW LAIDLAW RD PORTLAND OR, 97229

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