Moda Health Plan, Moda Health Local Enhanced Klamath Inc. (PPO) H3813 006 PPO No Alternative $40.60 $57.40 $22.60 PacificSource Medicare PacificSource Essentials Rx 6 Enhanced Klamath Medicare (HMO) H3864 006 HMO No Alternative $134.80 $50.30 $35.40 PacificSource Medicare PacificSource Essentials Choice Enhanced Klamath Medicare Rx 14 (HMO-POS) 014 HMOPOS No Alternative $73.80 $34.00 $19.20 PacificSource Medicare PacificSource Essentials Rx 27 Basic Klamath Medicare (HMO) H3864 027 HMO No Alternative $67.70 $54.30 $19.50 ATRIO Bronze Rx Local Enhanced Klamath Health Plans (Basin) (PPO) H6743 001 PPO No Alternative $0.00 $21.00 $0.00 ATRIO Silver Rx Enhanced Klamath Health Plans (PPO) 003 PPO No Alternative $80.40 $32.60 $0.00 ATRIO Health ATRIO Gold Rx Local Enhanced Klamath Plans (PPO) H6743 004 PPO No Alternative $132.60 $32.60 $14.80 AgeRight AgeRight Advantage Health Defined Advantage Health Plan (HMO SNP) Standard Klamath Plan (HMO SNP) (HMO SNP) H1372 001 HMO Yes Institutional Benefit $0.00 $30.40 $0.00 ATRIO Special Defined ATRIO Health Needs Plan (HMO Standard Klamath Plans SNP) H3814 007 HMO Yes Benefit $0.00 $34.80 $0.00 Moda Health Plan, Moda Health Enhanced Lake Inc. PPORX (PPO) H3813 006 PPO No Alternative $40.60 $57.40 $22.60 PacificSource Medicare PacificSource Essentials Rx 6 Enhanced Lake Medicare (HMO) 006 HMO No Alternative $134.80 $50.30 $35.40
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
2017%20Medicare%20Advantage%20Prescription%20Drug%20Plan%20List.docx