Plan Details
| Plan Year: | 2018 |
|---|---|
| Prescription Drugs Covered? | Yes |
| Health Plan Deductible | $0 |
| Monthly Drug Plan Premium | $8.3 |
| Monthly Health Plan Premium | $0 |
Coverage Area for Providence Medicare Extra Part B Only + RX (HMO)
| State | Oregon |
|---|---|
| County | Multnomah |
Cost Sharing Information
All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit
| 30 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
|---|---|---|---|
| Tier 1: Preferred Generic | $6 copay | $12 copay | Not offered |
| Tier 2: Non-Preferred Generic | $15 copay | $20 copay | Not offered |
| Tier 3: Preferred Brand Name | $45 copay | $45 copay | Not offered |
| Tier 4: Non-Preferred Brand Name | 25% coinsurance | 25% coinsurance | Not offered |
| Tier 5: Specialty Tier | 33% coinsurance | 33% coinsurance | Not offered |
| 90 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
|---|---|---|---|
| Tier 1: Preferred Generic | $14.4 copay | $36 copay | Not offered |
| Tier 2: Non-Preferred Generic | $36 copay | $60 copay | Not offered |
| Tier 3: Preferred Brand Name | $108 copay | $135 copay | Not offered |
| Tier 4: Non-Preferred Brand Name | 25% coinsurance | 25% coinsurance | Not offered |
| Tier 5: Specialty Tier |
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
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
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