PacificSource Medicare PacificSource Essentials Choice Enhanced Sherman Medicare Rx 14 (HMO-POS) H3864 014 HMOPOS No Alternative $73.80 $34.00 $19.20 PacificSource Medicare PacificSource Essentials Rx 27 Basic Sherman Medicare (HMO) H3864 027 HMO No Alternative $67.70 $54.30 $19.50 Moda Health Plan, Moda Health HMO Enhanced Sherman Inc. (HMO-POS) H8506 001 HMOPOS No Alternative $0.00 $63.00 $28.20 Providence ElderPlace Providence Portland (dual National Tillamook ElderPlace Portland eligible) (PACE) H3809 001 PACE No $161.70 $0.00 Providence ElderPlace Providence Portland (private National Tillamook ElderPlace Portland pay) (PACE) H3809 002 PACE No $125.50 $498.80 Moda Health Plan, Moda Health Local Enhanced Tillamook Inc. PPORX (PPO) H3813 006 PPO No Alternative $40.60 $57.40 $22.60 CareOregon CareOregon Advantage Star Enhanced Tillamook Advantage (HMO-POS) H5859 003 HMOPOS No Alternative $0.00 $34.80 $0.00 CareOregon Defined CareOregon Advantage Plus Standard Tillamook Advantage (HMO-POS SNP) H5859 001 HMOPOS Yes Benefit $0.00 $34.80 $0.00 Moda Health Plan, Moda Health Local Enhanced Umatilla Inc. PPORX (PPO) H3813 006 PPO No Alternative $40.60 $57.40 $22.60 Moda Health Plan, Moda Health HMO Enhanced Umatilla Inc. (HMO-POS) H8506 001 HMOPOS No Alternative $0.00 $63.00 $28.20 Moda Health Plan, Moda Health Local Enhanced Union Inc. PPORX (PPO) H3813 006 PPO No Alternative $40.60 $57.40 $22.60 Moda Health Plan, Moda Health HMO Enhanced Union Inc. (HMO-POS) H8506 001 HMOPOS No Alternative $0.00 $63.00 $28.20
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
2017%20Medicare%20Advantage%20Prescription%20Drug%20Plan%20List.docx