Benton Humana Insurance Company HumanaChoice H6609-073 (PPO) H6609 073 Local PPO No Alternative $168.90 $32.10 $0.00 Benton Health Net Health Plan of Oregon, Inc. Health Net Ruby (HMO) H6815 003 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Benton Kaiser Permanente Kaiser Permanente Senior Advantage (HMO) H9003 001 HMO No Enhanced Alternative $61.00 $41.50 $31.20 Benton Kaiser Permanente Kaiser Permanente Senior Advantage Basic (HMO) H9003 006 HMO No Enhanced Alternative $14.70 $29.30 $0.00 Benton UnitedHealthcare UnitedHealthcare Nursing Home Plan (PPO SNP) 016 PPO Yes Institutional Defined Standard Benefit $0.00 $28.70 $0.00 Benton UnitedHealthcare UnitedHealthcare Assisted Living Plan (PPO SNP) 017 Local PPO Yes Institutional Basic Alternative $0.00 $24.90 $0.00 Benton Samaritan Advantage Health Plan Samaritan Advantage Special Needs Plan (HMO SNP) H3811 003 HMO Yes Defined Standard Benefit $0.00 $34.80 $0.00 Benton Health Net Health Plan of Oregon, Inc. Health Net Jade (HMO SNP) H6815 004 HMO Yes Chronic or Disabling Condition Enhanced Alternative $0.00 $0.00 $0.00 Clackamas Humana Medical Plan, Inc. Humana Gold Plus (HMO) 153 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Clackamas UnitedHealthcare AARP MedicareComplete Choice (PPO) H2228 029 Local PPO No Enhanced Alternative $2.50 $29.50 $0.00 Clackamas UnitedHealthcare AARP MedicareComplete Plan 1 (HMO) H3805 001 HMO No Enhanced Alternative $40.50 $26.50 $0.00 Clackamas UnitedHealthcare AARP MedicareComplete Plan 2 (HMO) H3805 012 HMO No Enhanced Alternative $0.00 $0.00 $0.00
Clackamas FamilyCare Health FamilyCare Community (HMO SNP) H3818 002 HMO Yes Enhanced Alternative $0.00 $31.40 $0.00 Clackamas CareOregon Advantage CareOregon Advantage Plus (HMO-POS SNP) 001 HMOPOS Yes Defined Standard Benefit $0.00 $34.80 $0.00 Clackamas Health Net Health Plan of Oregon, Inc. Health Net Jade (HMO SNP) H6815 004 HMO Yes Chronic or Disabling Condition Enhanced Alternative $0.00 $0.00 $0.00 Clackamas Providence Health Assurance Providence Medicare Dual Plus (HMO SNP) 043 HMO Yes Defined Standard Benefit $0.00 $34.80 $0.00 Clatsop Providence ElderPlace Portland Providence ElderPlace Portland (dual eligible) (PACE) H3809 001 National PACE No $161.70 $0.00 Clatsop Providence ElderPlace Portland Providence ElderPlace Portland (private pay) (PACE) H3809 002 National PACE No $125.50 $498.80 Clatsop Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Clatsop FamilyCare Health FamilyCare Advantage Rx (HMO) H3818 003 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Clatsop CareOregon Advantage CareOregon Advantage Star (HMO-POS) 003 HMOPOS No Enhanced Alternative $0.00 $34.80 $0.00 Clatsop FamilyCare Health FamilyCare Community (HMO SNP) H3818 002 HMO Yes Enhanced Alternative $0.00 $31.40 $0.00 Clatsop CareOregon Advantage CareOregon Advantage Plus (HMO-POS SNP) H5859 001 HMOPOS Yes Defined Standard Benefit $0.00 $34.80 $0.00 Columbia Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60
Columbia Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Classic (PPO) H3817 008 Local PPO No Basic Alternative $51.50 $49.50 $14.70 Columbia Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Enhanced (PPO) H3817 009 Local PPO No Enhanced Alternative $147.40 $66.90 $55.80 Columbia CareOregon Advantage CareOregon Advantage Star (HMO-POS) H5859 003 HMOPOS No Enhanced Alternative $0.00 $34.80 $0.00 Columbia Humana Insurance Company HumanaChoice H6609-073 (PPO) 073 Local PPO No Basic Alternative $168.90 $32.10 $0.00 Columbia Kaiser Permanente Kaiser Permanente Senior Advantage (HMO) H9003 001 HMO No Enhanced Alternative $61.00 $41.50 $31.20 Columbia Kaiser Permanente Kaiser Permanente Senior Advantage Basic (HMO) H9003 006 HMO No Enhanced Alternative $14.70 $29.30 $0.00 Columbia Providence Health Assurance Providence Medicare Extra + RX (HMO) H9047 001 HMO No Enhanced Alternative $109.10 $52.50 $18.10 Columbia Providence Health Assurance Providence Medicare Extra Part B Only + RX (HMO) H9047 013 HMO No Enhanced Alternative $375.60 $42.10 $7.30 Columbia Providence Health Assurance Providence Medicare Choice + RX (HMO-POS) H9047 024 HMOPOS No Enhanced Alternative $39.50 $48.50 $13.70 Columbia CareOregon Advantage CareOregon Advantage Plus (HMO-POS SNP) H5859 001 HMOPOS Yes Defined Standard Benefit $0.00 $34.80 $0.00 Coos Moda Health Plan, Inc. Moda Health (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60
Douglas ATRIO Health Plans ATRIO Special Needs Plan (HMO SNP) H3814 007 HMO Yes Defined Standard Benefit $0.00 $34.80 $0.00 Gilliam Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 PPO No Enhanced Alternative $40.60 $57.40 $22.60 Gilliam Moda Health Plan, Inc. Moda Health HMO (HMO-POS) 001 HMOPOS No Enhanced Alternative $0.00 $63.00 $28.20 Grant Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Grant PacificSource Medicare PacificSource Medicare Essentials Rx 6 (HMO) H3864 006 HMO No Enhanced Alternative $134.80 $50.30 $35.40 PacificSource Medicare PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) H3864 014 HMOPOS No Enhanced Alternative $73.80 $34.00 $19.20 Grant PacificSource Medicare PacificSource Medicare Essentials Rx 27 (HMO) 027 HMO No Basic Alternative $67.70 $54.30 $19.50 Moda Health Plan, Inc. Moda Health HMO (HMO-POS) H8506 001 HMOPOS No Enhanced Alternative $0.00 $63.00 $28.20 Harney Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Harney Moda Health Plan, Inc. Moda Health HMO (HMO-POS) H8506 001 HMOPOS No Enhanced Alternative $0.00 $63.00 $28.20 Hood Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Hood River PacificSource Medicare PacificSource Medicare Essentials Rx 6 (HMO) H3864 006 HMO No Enhanced Alternative $134.80 $50.30 $35.40
Hood River PacificSource Medicare PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) H3864 014 HMOPOS No Enhanced Alternative $73.80 $34.00 $19.20 Hood River PacificSource Medicare PacificSource Medicare Essentials Rx 27 (HMO) H3864 027 HMO No Alternative $67.70 $54.30 $19.50 Hood River Humana Insurance Company HumanaChoice (PPO) H6609 073 Local PPO No Basic Alternative $168.90 $32.10 $0.00 Hood River Providence Health Assurance Providence Medicare Latitude + RX (HMO-POS) 038 HMOPOS No Enhanced Alternative $111.60 $46.40 $22.60 Hood River Providence Health Assurance Providence Medicare Compass + RX (HMO-POS) H9047 039 HMOPOS No Enhanced Alternative $59.70 $39.30 $4.50 Jackson AllCare Advantage AllCare Advantage Gold Plus Rx (HMO) H3810 003 HMO No Enhanced Alternative $90.60 $50.90 $16.10 Jackson Moda Health Plan, Inc. Moda Health (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Jackson Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Classic (PPO) H3817 008 Local PPO No Basic Alternative $51.50 $49.50 $14.70 Jackson Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Enhanced (PPO) H3817 009 Local PPO No Enhanced Alternative $147.40 $66.90 $55.80 Jackson Health Net Life Insurance Company Health Net Violet Option 1 (PPO) H5520 004 Local PPO No Enhanced Alternative $71.10 $33.90 $0.00 Jackson Health Net Life Insurance Company Health Net Violet Option 2 (PPO) 015 Local PPO No Basic Alternative $0.00 $25.00 $0.00 Jackson ATRIO Health Plans ATRIO Bronze Rx (Rogue) (PPO) H6743 014 Local PPO No Enhanced Alternative $0.00 $0.00 $0.00
Jackson ATRIO Health Plans Silver Rx (Rogue) (PPO) H6743 016 Local PPO No Enhanced Alternative $67.20 $13.50 $22.30 Jackson ATRIO Health Plans Gold Rx (Rogue) (PPO) 017 Local PPO No Enhanced Alternative $100.50 $29.00 $35.50 Jackson ATRIO Health Plans Special Needs Plan (Rogue) (HMO SNP) H3814 029 HMO Yes Defined Standard Benefit $0.00 $34.80 $0.00 Jackson CareOregon Advantage CareOregon Advantage Plus (HMO-POS SNP) H5859 001 HMOPOS Yes Defined Standard Benefit $0.00 $34.80 $0.00 Jefferson Humana Medical Plan, Inc. Humana Gold Plus H1036-219 (HMO) H1036 219 HMO No Enhanced Alternative $47.60 $16.10 $7.30 Jefferson Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Jefferson PacificSource Medicare PacificSource Medicare Essentials Rx 6 (HMO) H3864 006 HMO No Enhanced Alternative $134.80 $50.30 $35.40 Jefferson PacificSource Medicare PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) H3864 014 HMOPOS No Enhanced Alternative $73.80 $34.00 $19.20 Jefferson PacificSource Medicare PacificSource Medicare Essentials Rx 27 (HMO) H3864 027 HMO No Basic Alternative $67.70 $54.30 $19.50 Jefferson Humana Insurance Company HumanaChoice H6609-013 (PPO) H6609 013 Local PPO No Enhanced Alternative $66.40 $31.50 $4.10 Jefferson Humana Insurance Company HumanaChoice H6609-073 (PPO) H6609 073 Local PPO No Alternative $168.90 $32.10 $0.00 Jefferson Providence Health Assurance Providence Medicare Latitude + RX (HMO-POS) 038 HMOPOS No Enhanced Alternative $111.60 $46.40 $22.60
Klamath Moda Health Plan, Inc. Moda Health (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Klamath PacificSource Medicare PacificSource Medicare Essentials Rx 6 (HMO) H3864 006 HMO No Enhanced Alternative $134.80 $50.30 $35.40 Klamath PacificSource Medicare PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) 014 HMOPOS No Enhanced Alternative $73.80 $34.00 $19.20 Klamath PacificSource Medicare PacificSource Medicare Essentials Rx 27 (HMO) H3864 027 HMO No Basic Alternative $67.70 $54.30 $19.50 Klamath Health Plans ATRIO Bronze Rx (Basin) (PPO) H6743 001 Local PPO No Enhanced Alternative $0.00 $21.00 $0.00 Klamath Health Plans ATRIO Silver Rx (PPO) 003 PPO No Enhanced Alternative $80.40 $32.60 $0.00 Klamath ATRIO Health Plans ATRIO Gold Rx (PPO) H6743 004 Local PPO No Enhanced Alternative $132.60 $32.60 $14.80 Klamath AgeRight Advantage Health Plan (HMO SNP) AgeRight Advantage Health Plan (HMO SNP) (HMO SNP) H1372 001 HMO Yes Institutional Defined Standard Benefit $0.00 $30.40 $0.00 Klamath ATRIO Health Plans ATRIO Special Needs Plan (HMO SNP) H3814 007 HMO Yes Defined Standard Benefit $0.00 $34.80 $0.00 Lake Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 PPO No Enhanced Alternative $40.60 $57.40 $22.60 Lake PacificSource Medicare PacificSource Medicare Essentials Rx 6 (HMO) 006 HMO No Enhanced Alternative $134.80 $50.30 $35.40
Lake PacificSource Medicare PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) 014 HMOPOS No Enhanced Alternative $73.80 $34.00 $19.20 Lake PacificSource Medicare PacificSource Medicare Essentials Rx 27 (HMO) H3864 027 HMO No Basic Alternative $67.70 $54.30 $19.50 Lake Moda Health Plan, Inc. Moda Health HMO (HMO-POS) H8506 001 HMOPOS No Enhanced Alternative $0.00 $63.00 $28.20 Lane UnitedHealthcare AARP MedicareComplete Choice (PPO) H2228 029 Local PPO No Enhanced Alternative $2.50 $29.50 $0.00 Lane UnitedHealthcare AARP MedicareComplete Plan 1 (HMO) 007 HMO No Enhanced Alternative $24.80 $21.20 $0.00 Lane UnitedHealthcare AARP MedicareComplete Plan 2 (HMO) H3805 013 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Lane Moda Health Plan, Inc. Moda Health (PPO) H3813 006 PPO No Enhanced Alternative $40.60 $57.40 $22.60 Lane Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Classic (PPO) H3817 008 Local PPO No Basic Alternative $2.00 $41.00 $6.20 Lane Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Enhanced (PPO) H3817 009 Local PPO No Enhanced Alternative $106.40 $66.90 $55.80 Lane PacificSource Medicare PacificSource Medicare Essentials Rx 26 (HMO) 026 HMO No Enhanced Alternative $38.00 $31.00 $0.00 Lane PacificSource Medicare PacificSource Medicare Explorer Rx 4 (PPO) H4754 004 Local PPO No Enhanced Alternative $95.50 $46.50 $31.70
Lincoln Samaritan Advantage Health Plan Samaritan Advantage Premier Plan (HMO) H3811 002 HMO No Enhanced Alternative $56.60 $53.40 $18.60 Lincoln Samaritan Advantage Health Plan Samaritan Advantage Premier Plan Plus (HMO) H3811 009 HMO No Enhanced Alternative $70.90 $69.10 $34.30 Lincoln Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Lincoln Humana Insurance Company HumanaChoice H6609-073 (PPO) H6609 073 Local PPO No Basic Alternative $168.90 $32.10 $0.00 Lincoln Samaritan Advantage Health Plan Samaritan Advantage Special Needs Plan (HMO SNP) 003 HMO Yes Defined Standard Benefit $0.00 $34.80 $0.00 Linn UnitedHealthcare AARP MedicareComplete Plan 1 (HMO) H3805 007 HMO No Enhanced Alternative $24.80 $21.20 $0.00 Linn UnitedHealthcare AARP MedicareComplete Plan 2 (HMO) H3805 013 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Linn Samaritan Advantage Health Plan Samaritan Advantage Premier Plan (HMO) H3811 002 HMO No Enhanced Alternative $56.60 $53.40 $18.60 Linn Samaritan Advantage Health Plan Samaritan Advantage Premier Plan Plus (HMO) H3811 009 HMO No Enhanced Alternative $70.90 $69.10 $34.30 Linn Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Linn Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Classic (PPO) H3817 008 PPO No Basic Alternative $51.50 $49.50 $14.70 Linn Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Enhanced (PPO) H3817 009 Local PPO No Enhanced Alternative $147.40 $66.90 $55.80
Multnomah UnitedHealthcare AARP MedicareComplete Plan 2 (HMO) H3805 012 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Multnomah Providence ElderPlace Portland Providence ElderPlace Portland (dual eligible) (PACE) H3809 001 National PACE No $161.70 $0.00 Multnomah Providence ElderPlace Portland Providence ElderPlace Portland (private pay) (PACE) H3809 002 National PACE No $125.50 $498.80 Multnomah Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Multnomah Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Classic (PPO) H3817 008 Local PPO No Basic Alternative $2.00 $41.00 $6.20 Multnomah Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Enhanced (PPO) 009 Local PPO No Enhanced Alternative $106.40 $66.90 $55.80 Multnomah FamilyCare Health FamilyCare Advantage Rx (HMO) H3818 003 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Multnomah PacificSource Medicare PacificSource Medicare MyCare Rx 22 (HMO) H3864 022 HMO No Enhanced Alternative $48.80 $29.20 $0.00 Multnomah Health Net Life Insurance Company Health Net Violet Option 1 (PPO) H5520 002 Local PPO No Enhanced Alternative $76.30 $39.70 $4.90 Multnomah Health Net Life Insurance Company Health Net Violet Option 2 (PPO) H5520 012 Local PPO No Basic Alternative $0.00 $19.00 $0.00 Multnomah CareOregon Advantage CareOregon Advantage Star (HMO-POS) H5859 003 HMOPOS No Enhanced Alternative $0.00 $34.80 $0.00
Multnomah Regence BlueCross BlueShield of Oregon Regence BlueAdvantage HMO (HMO) H6237 003 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Multnomah Health Net Health Plan of Oregon, Inc. Health Net Ruby (HMO) H6815 003 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Multnomah Humana Insurance Company Humana Gold Choice H8145-093 (PFFS) H8145 093 PFFS No Enhanced Alternative $47.60 $34.90 $4.60 Multnomah Kaiser Permanente Kaiser Permanente Senior Advantage (HMO) H9003 001 HMO No Enhanced Alternative $61.00 $41.50 $31.20 Multnomah Kaiser Permanente Kaiser Permanente Senior Advantage Basic (HMO) H9003 006 HMO No Enhanced Alternative $14.70 $29.30 $0.00 Multnomah Providence Health Assurance Providence Medicare Extra + RX (HMO) H9047 001 HMO No Enhanced Alternative $109.10 $52.50 $18.10 Multnomah Providence Health Assurance Providence Medicare Extra Part B Only + RX (HMO) H9047 013 HMO No Enhanced Alternative $375.60 $42.10 $7.30 Multnomah Providence Health Assurance Providence Medicare Choice + RX (HMO-POS) H9047 024 HMOPOS No Enhanced Alternative $39.50 $48.50 $13.70 Multnomah Providence Health Assurance Providence Medicare + RX (HMO-POS) 037 HMOPOS No Enhanced Alternative $0.00 $0.00 $0.00 Multnomah AgeRight Advantage Health Plan (HMO SNP) AgeRight Advantage Health Plan (HMO SNP) (HMO SNP) 001 HMO Yes Institutional Defined Standard Benefit $0.00 $30.40 $0.00 Multnomah UnitedHealthcare UnitedHealthcare Nursing Home Plan (PPO SNP) H2228 016 PPO Yes Institutional Defined Standard Benefit $0.00 $28.70 $0.00
Multnomah UnitedHealthcare UnitedHealthcare Assisted Living Plan (PPO SNP) H2228 017 Local PPO Yes Institutional Basic Alternative $0.00 $24.90 $0.00 Multnomah FamilyCare Health FamilyCare Community (HMO SNP) 002 HMO Yes Enhanced Alternative $0.00 $31.40 $0.00 Multnomah CareOregon Advantage CareOregon Advantage Plus (HMO-POS SNP) H5859 001 HMOPOS Yes Defined Standard Benefit $0.00 $34.80 $0.00 Multnomah Health Net Health Plan of Oregon, Inc. Health Net Jade (HMO SNP) H6815 004 HMO Yes Chronic or Disabling Condition Enhanced Alternative $0.00 $0.00 $0.00 Multnomah Providence Health Assurance Providence Medicare Dual Plus (HMO SNP) H9047 043 HMO Yes Defined Standard Benefit $0.00 $34.80 $0.00 Polk UnitedHealthcare AARP MedicareComplete Plan 1 (HMO) H3805 001 HMO No Enhanced Alternative $40.50 $26.50 $0.00 Polk UnitedHealthcare AARP MedicareComplete Plan 2 (HMO) H3805 012 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Polk Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Polk Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Classic (PPO) H3817 008 Local PPO No Alternative $51.50 $49.50 $14.70 Polk Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Enhanced (PPO) H3817 009 Local PPO No Enhanced Alternative $147.40 $66.90 $55.80 Polk Health Net Life Insurance Company Health Net Violet Option 1 (PPO) H5520 002 Local PPO No Enhanced Alternative $76.30 $39.70 $4.90 Polk Health Net Life Insurance Company Health Net Violet Option 2 (PPO) H5520 012 Local PPO No Basic Alternative $0.00 $32.00 $0.00
Polk Regence BlueCross BlueShield of Oregon Regence BlueAdvantage HMO (HMO) H6237 003 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Polk Health Net Health Plan of Oregon, Inc. Health Net Ruby (HMO) H6815 003 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Polk ATRIO Health Plans ATRIO Gold Rx (Willamette) (PPO) H7006 001 Local PPO No Enhanced Alternative $139.50 $45.50 $10.70 Polk ATRIO Health Plans ATRIO Silver Rx (Willamette) (PPO) 003 Local PPO No Enhanced Alternative $54.10 $12.90 $0.00 Polk Kaiser Permanente Kaiser Permanente Senior Advantage (HMO) H9003 001 HMO No Enhanced Alternative $61.00 $41.50 $31.20 Polk Kaiser Permanente Kaiser Permanente Senior Advantage Basic (HMO) 006 HMO No Enhanced Alternative $14.70 $29.30 $0.00 Polk Providence Health Assurance Providence Medicare Extra + RX (HMO) H9047 001 HMO No Enhanced Alternative $109.10 $52.50 $18.10 Polk Providence Health Assurance Providence Medicare Part B Only + RX (HMO) H9047 013 HMO No Enhanced Alternative $375.60 $42.10 $7.30 Polk Providence Health Assurance Providence Medicare Choice + RX (HMO-POS) 024 HMOPOS No Enhanced Alternative $39.50 $48.50 $13.70 Polk Health Plans ATRIO Special Needs Plan (Willamette) (HMO SNP) H5995 001 HMO Yes Defined Standard Benefit $0.00 $34.80 $0.00 Sherman Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Sherman PacificSource Medicare PacificSource Medicare Essentials Rx 6 (HMO) 006 HMO No Enhanced Alternative $134.80 $50.30 $35.40
Sherman PacificSource Medicare PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) H3864 014 HMOPOS No Enhanced Alternative $73.80 $34.00 $19.20 Sherman PacificSource Medicare PacificSource Medicare Essentials Rx 27 (HMO) H3864 027 HMO No Basic Alternative $67.70 $54.30 $19.50 Sherman Moda Health Plan, Inc. Moda Health HMO (HMO-POS) H8506 001 HMOPOS No Enhanced Alternative $0.00 $63.00 $28.20 Tillamook Providence ElderPlace Portland Providence ElderPlace Portland (dual eligible) (PACE) H3809 001 National PACE No $161.70 $0.00 Tillamook Providence ElderPlace Portland Providence ElderPlace Portland (private pay) (PACE) H3809 002 National PACE No $125.50 $498.80 Tillamook Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Tillamook CareOregon Advantage CareOregon Advantage Star (HMO-POS) H5859 003 HMOPOS No Enhanced Alternative $0.00 $34.80 $0.00 Tillamook CareOregon Advantage CareOregon Advantage Plus (HMO-POS SNP) H5859 001 HMOPOS Yes Defined Standard Benefit $0.00 $34.80 $0.00 Umatilla Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Umatilla Moda Health Plan, Inc. Moda Health HMO (HMO-POS) H8506 001 HMOPOS No Enhanced Alternative $0.00 $63.00 $28.20 Union Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Union Moda Health Plan, Inc. Moda Health HMO (HMO-POS) H8506 001 HMOPOS No Enhanced Alternative $0.00 $63.00 $28.20
Wallowa Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Wallowa Moda Health Plan, Inc. Moda Health HMO (HMO-POS) 001 HMOPOS No Enhanced Alternative $0.00 $63.00 $28.20 Moda Health Plan, Inc. Moda Health (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Wasco PacificSource Medicare PacificSource Medicare Essentials Rx 6 (HMO) H3864 006 HMO No Enhanced Alternative $134.80 $50.30 $35.40 Wasco PacificSource Medicare PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) H3864 014 HMOPOS No Enhanced Alternative $73.80 $34.00 $19.20 Wasco PacificSource Medicare PacificSource Medicare Essentials Rx 27 (HMO) 027 HMO No Basic Alternative $67.70 $54.30 $19.50 Washington Humana Medical Plan, Inc. Humana Gold Plus H1036-153 (HMO) H1036 153 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Washington UnitedHealthcare AARP MedicareComplete Choice (PPO) H2228 029 PPO No Enhanced Alternative $2.50 $29.50 $0.00 Washington UnitedHealthcare AARP MedicareComplete Plan 1 (HMO) H3805 001 HMO No Enhanced Alternative $40.50 $26.50 $0.00 Washington UnitedHealthcare AARP MedicareComplete Plan 2 (HMO) H3805 012 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Washington Providence ElderPlace Portland Providence ElderPlace Portland (dual eligible) (PACE) H3809 001 National PACE No $161.70 $0.00
Washington Kaiser Permanente Kaiser Permanente Senior Advantage (HMO) H9003 001 HMO No Enhanced Alternative $61.00 $41.50 $31.20 Washington Kaiser Permanente Kaiser Permanente Senior Advantage Basic (HMO) 006 HMO No Enhanced Alternative $14.70 $29.30 $0.00 Washington Providence Health Assurance Providence Medicare Extra + RX (HMO) H9047 001 HMO No Enhanced Alternative $109.10 $52.50 $18.10 Washington Providence Health Assurance Providence Medicare Extra Part B Only + RX (HMO) H9047 013 HMO No Enhanced Alternative $375.60 $42.10 $7.30 Washington Providence Health Assurance Providence Medicare Choice + RX (HMO-POS) H9047 024 HMOPOS No Enhanced Alternative $39.50 $48.50 $13.70 Washington Providence Health Assurance Providence Medicare Prime + RX (HMO-POS) H9047 037 HMOPOS No Enhanced Alternative $0.00 $0.00 $0.00 Washington AgeRight Advantage Health Plan (HMO SNP) AgeRight Advantage Health Plan (HMO SNP) (HMO SNP) H1372 001 HMO Yes Institutional Defined Standard Benefit $0.00 $30.40 $0.00 Washington UnitedHealthcare UnitedHealthcare Nursing Home Plan (PPO SNP) H2228 016 Local PPO Yes Institutional Defined Standard Benefit $0.00 $28.70 $0.00 Washington UnitedHealthcare UnitedHealthcare Assisted Living Plan (PPO SNP) H2228 017 Local PPO Yes Institutional Alternative $0.00 $24.90 $0.00 Washington FamilyCare Health FamilyCare Community (HMO SNP) H3818 002 HMO Yes Enhanced Alternative $0.00 $31.40 $0.00 Washington CareOregon Advantage CareOregon Advantage Plus (HMO-POS SNP) 001 HMOPOS Yes Defined Standard Benefit $0.00 $34.80 $0.00
Washington Health Net Health Plan of Oregon, Inc. Health Net Jade (HMO SNP) H6815 004 HMO Yes Chronic or Disabling Condition Enhanced Alternative $0.00 $0.00 $0.00 Washington Providence Health Assurance Providence Medicare Dual Plus (HMO SNP) H9047 043 HMO Yes Defined Standard Benefit $0.00 $34.80 $0.00 Wheeler Moda Health Plan, Inc. Moda Health PPORX (PPO) 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Wheeler PacificSource Medicare PacificSource Medicare Essentials Rx 6 (HMO) H3864 006 HMO No Enhanced Alternative $134.80 $50.30 $35.40 Wheeler PacificSource Medicare PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) H3864 014 HMOPOS No Enhanced Alternative $73.80 $34.00 $19.20 Wheeler PacificSource Medicare PacificSource Medicare Essentials Rx 27 (HMO) H3864 027 HMO No Alternative $67.70 $54.30 $19.50 Wheeler Moda Health Plan, Inc. Moda Health HMO (HMO-POS) H8506 001 HMOPOS No Enhanced Alternative $0.00 $63.00 $28.20 Wheeler Providence Health Assurance Providence Medicare Latitude + RX (HMO-POS) H9047 038 HMOPOS No Enhanced Alternative $111.60 $46.40 $22.60 Wheeler Providence Health Assurance Providence Medicare Compass + RX (HMO-POS) H9047 039 HMOPOS No Enhanced Alternative $59.70 $39.30 $4.50 Yamhill UnitedHealthcare AARP MedicareComplete Choice (PPO) H2228 029 PPO No Enhanced Alternative $2.50 $29.50 $0.00 Yamhill UnitedHealthcare AARP MedicareComplete Plan 1 (HMO) H3805 001 HMO No Enhanced Alternative $40.50 $26.50 $0.00
Yamhill UnitedHealthcare AARP MedicareComplete Plan 2 (HMO) H3805 012 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Yamhill Moda Health Plan, Inc. Moda Health PPORX (PPO) H3813 006 Local PPO No Enhanced Alternative $40.60 $57.40 $22.60 Yamhill Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Classic (PPO) H3817 008 Local PPO No Basic Alternative $51.50 $49.50 $14.70 Yamhill Regence BlueCross BlueShield of Oregon Regence MedAdvantage + Rx Enhanced (PPO) H3817 009 PPO No Enhanced Alternative $147.40 $66.90 $55.80 Yamhill Health Net Life Insurance Company Health Net Violet Option 1 (PPO) 002 PPO No Enhanced Alternative $76.30 $39.70 $4.90 Yamhill Health Net Life Insurance Company Health Net Violet Option 2 (PPO) H5520 012 Local PPO No Basic Alternative $0.00 $24.00 $0.00 Yamhill CareOregon Advantage CareOregon Advantage Star (HMO-POS) H5859 003 HMOPOS No Enhanced Alternative $0.00 $34.80 $0.00 Yamhill Health Net Health Plan of Oregon, Inc. Health Net Ruby (HMO) 003 HMO No Enhanced Alternative $0.00 $0.00 $0.00 Yamhill Kaiser Permanente Kaiser Permanente Senior Advantage (HMO) H9003 001 HMO No Enhanced Alternative $61.00 $41.50 $31.20 Yamhill Kaiser Permanente Kaiser Permanente Senior Advantage Basic (HMO) 006 HMO No Enhanced Alternative $14.70 $29.30 $0.00 Yamhill Providence Health Assurance Providence Medicare Extra + RX (HMO) H9047 001 HMO No Enhanced Alternative $109.10 $52.50 $18.10 Yamhill AgeRight Advantage Health Plan (HMO SNP) AgeRight Advantage Health Plan (HMO SNP) (HMO SNP) H1372 001 HMO Yes Institutional Defined Standard Benefit $0.00 $30.40 $0.00