Information Memorandum Aging and People with … 3 Part D Premium Obligation with Full Premium...

MSC 0080 (08/15)

Information MemorandumTransmittal Aging and People with Disabilities

Kevin Nygren

Number: APD-IM-16-114 Authorized signature Issue date: 12/22/2016 Topic: Other Subject: Oregon's 2017 Medicare Advantage Plans Applies to (check all that apply):

All DHS employees County Mental Health Directors Area Agencies on Aging Health Services Aging and People with Disabilities Office of Developmental

Disabilities Services(ODDS) Self Sufficiency Programs County DD Program Managers ODDS Children’s Intensive

In Home Services ODDS Children’s Residential Services

Stabilization and Crisis Unit (SACU)

Child Welfare Programs Other (please specify): Message: Recently, the Centers for Medicare and Medicaid Services (CMS) announced the 2017 Medicare Advantage and Medicare Advantage Prescription Drug Plans (MA-PDs). MA plans are offered by a private company that contracts with Medicare to provide beneficiaries with all their Medicare Part B benefits. MA-PD plans are Medicare Advantage plans that offer Medicare Prescription Drug coverage along with Part A and Part B benefits in one plan. Medicare Advantage Plans are HMOs, PPOs, or Private Fee-for-Service Plans. When a client is enrolled in a Medicare Advantage Plan the Medicare services are paid through the plans, and are not paid through Original Medicare. The 1st attached document is the CCO and Affiliated Medicare Advantage list. The 2nd attached document is the Medicare Advantage Health Plan enrollment contact list.

MSC 0080 (08/15)

The 3rd attached document is the “2017 MA-PDs” plan list. The MA-PDs are alphabetically arranged by county. MA-PDs Special Needs Plans (SNP) are highlighted in yellow.

If you have any questions about this information, contact: Contact(s): Kesha Baxter

Phone: 503-945-6082 Fax: Email: [email protected]

12/20/2016

Coordinated Care (CCO) Affiliated

Plan

Medicare Advantage Plan

Name

Medicare Advantage Plan Service Area

AllCare Health Plan CareSource Josephine Jackson Douglas (partial)

Cascade Health Alliance

ATRIO Health Plans

Klamath-all zip codes served except 97731, 97733,97737 & 97739

Columbia Pacific CareOregon Advantage

Clatsop, Columbia, Coos-97449; Tillamook

Eastern Oregon CCO Moda Health MO Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow Sherman, Umatilla, Union, Wallowa, Wheeler

FamilyCare FamilyCare MA Plan

Clackamas, Multnomah, Washington

Health Share

Care Oregon Adv. Providence Adv. Kaiser Senior Adv.

Clackamas, Multnomah, Washington

Intercommunity Health Network (IHN)

Samaritan Advantage

Benton, Lincoln, Linn

Jackson Care Connect

CareOregon Jackson

PacificSource Central Oregon

PacificSource MA Crook, Deschutes, Jefferson; Klamath-97731,97733, 97337 & 97339

PacificSource George PacificSource MA Hood River, Wasco Primary Health of Josephine County

ATRIO Health Plans

Josephine

Trillium Trillium MA Plans Lane

Umpqua ATRIO Health Plans

Douglas-all zip codes served except 97441,97467 & 97473

12/20/2016

Western Oregon Advanced Health (WOAH)

N/A None at this time

Willamette Valley Community Health (WVCH0

ATRIO Health Plan Benton-97361 Clackamas-97002,97032,97071,97362 & 97375 Linn-97346,97350,97352,97358,97360 & 97383 Marion Polk Yamhill-97304

Yamhill County CCO (YCCO)

CareOregon Advantage

Yamhill

12/22/2016 1

Medicare Advantage Health Plan Enrollment Contacts

Atrio Health Plans Phone: 541-672-8620, ask for the Enrollment Department

Fax or mail 7208M form to:

Fax: 541-672-7870

Mailing address

2270 N.W. Aviation Suite 3 Roseburg OR, 97470

CareOregon Advantage: Enrollment Department Phone: 503-416-4279

Fax form to:

Fax: 503-416-8117

CareSource Contact: Marketing Department

Phone: 888-460-0185

Fax, mail or e-mail 7208M form to:

Fax: 541-471-3784

12/22/2016 2

Mailing Address

740 SE 7TH St.

Grants Pass OR, 97526

www.Caresourcehealthplan.com . Family Care, Inc. Plan contacts:

Mark Weinsoft

Phone: 503 734-3110

Amber Kelsoell

503-488-3747

Fax or e-mail 7208M form to:

Fax: 503-345-5751

E-mail: [email protected]

Kaiser Permanente Senior Advantage Plan Contact: Danny Covarrubio

Phone: 1-858-614-3433

Fax form to:

Fax: 1-866-551-9598

12/22/2016 3

MODA Health Plan Inc. Contact: Billing and Eligibility

Phone: 503-382-5357 or 1-866-940-0357


Fax: 503-224-1975

Mailing address:

MODA Health Plan

601 S.W. 2nd Ave

Portland OR, 97204


Pacific Source

Contact: Bob Smith

Phone: 541-330-7325


Fax: 855-382-4217

Mailing address

Pacific Source

P.O. Box 7469

12/22/2016 4

Bend OR, 97708

Medicare applications can also be sent to

[email protected] via secure email

Providence Health Plan Contact: Sharena Kent

Phone: 503-574-7527


Fax: 503-574-8607

Mailing address:

Providence Health Plan

P.O. Box 5548

Portland OR, 97228

Samaritan Advantage Health Plan Brenda Page

541-768-4487

Samaritan Advantage Enrollment line

1-800-832-4580


Fax: 541-768-9778 (Attention: Enrollment Department)

12/22/2016 5

Mailing address:

Samaritan Advantage Health Plan

P.O. Box M

Corvallis OR, 97339

Trillium Contact: Billie Stoltz


Phone: 541-431-1950 x 1283


Fax: 541-984-5690

Trillium Health Plan

P.O. Box 11756

Eugene OR, 97440

Regence

Contact: Government Programs (Customer Service)

Phone: 1-800-541-8981


Fax: 1-888-335-2988

12/22/2016 6

Mailing Address:

P.O. Box 12685

Salem OR, 97309

***Enrollment and dis-enrollment decisions must be documented using the

7208M and 7209 forms and sent to the MA plan

1

County Organization

Name Plan Name Contract

ID Plan ID Plan Type

Special Needs Plan

Special Needs

Plan Type Benefit Type

Part C Premium

2

Part D Basic

Premium3

Part D Premium

Obligation with Full Premium

Assistance

Baker Moda Health Plan, Inc.

Moda Health PPORX (PPO) H3813 006

Local PPO No

Enhanced Alternative $40.60 $57.40 $22.60

Baker Moda Health Plan, Inc.

Moda Health HMO (HMO-POS) H8506 001 HMOPOS No


Benton UnitedHealthcare

AARP MedicareComplete Plan 1 (HMO) H3805 007 HMO No





Benton


Samaritan Advantage Premier Plan (HMO) H3811 002 HMO No


Benton


Samaritan Advantage Premier Plan Plus (HMO) H3811 009 HMO No


Benton Moda Health Plan, Inc.


Local PPO No


Benton

Regence BlueCross BlueShield of Oregon

Regence MedAdvantage + Rx Classic (PPO) H3817 008

Local PPO No

Basic Alternative $51.50 $49.50 $14.70

Benton


Regence MedAdvantage + Rx Enhanced (PPO) H3817 009

Local PPO No


Benton Health Net Life Insurance Company

Health Net Violet Option 1 (PPO) H5520 002

Local PPO No


Benton Health Net Life Insurance Company


Local PPO No


2

Benton Humana Insurance Company

HumanaChoice H6609-073 (PPO) H6609 073

Local PPO No


Benton Health Net Health Plan of Oregon, Inc.

Health Net Ruby (HMO) H6815 003 HMO No


Benton Kaiser Permanente

Kaiser Permanente Senior Advantage (HMO) H9003 001 HMO No


Benton Kaiser Permanente

Kaiser Permanente Senior Advantage Basic (HMO) H9003 006 HMO No



UnitedHealthcare Nursing Home Plan (PPO SNP) H2228 016

Local PPO Yes Institutional

Defined Standard Benefit $0.00 $28.70 $0.00


UnitedHealthcare Assisted Living Plan (PPO SNP) H2228 017



Benton


Samaritan Advantage Special Needs Plan (HMO SNP) H3811 003 HMO Yes

Dual-Eligible


Benton Health Net Health Plan of Oregon, Inc.

Health Net Jade (HMO SNP) H6815 004 HMO Yes

Chronic or Disabling Condition


Clackamas Humana Medical Plan, Inc.

Humana Gold Plus H1036-153 (HMO) H1036 153 HMO No


Clackamas UnitedHealthcare

AARP MedicareComplete Choice (PPO) H2228 029

Local PPO No








3

Clackamas Providence ElderPlace Portland

Providence ElderPlace Portland (dual eligible) (PACE) H3809 001

National PACE No $161.70 $0.00

Clackamas Providence ElderPlace Portland

Providence ElderPlace Portland (private pay) (PACE) H3809 002


Clackamas Moda Health Plan, Inc.


Local PPO No


Clackamas



Local PPO No


Clackamas



Local PPO No


Clackamas FamilyCare Health

FamilyCare Advantage Rx (HMO) H3818 003 HMO No


Clackamas PacificSource Medicare

PacificSource Medicare MyCare Rx 22 (HMO) H3864 022 HMO No


Clackamas Health Net Life Insurance Company


Local PPO No


Clackamas Health Net Life Insurance Company


Local PPO No


Clackamas CareOregon Advantage

CareOregon Advantage Star (HMO-POS) H5859 003 HMOPOS No


Clackamas


Regence BlueAdvantage HMO (HMO) H6237 003 HMO No


Clackamas Health Net Health Plan of Oregon, Inc.



4

Clackamas Humana Insurance Company

Humana Gold Choice H8145-093 (PFFS) H8145 093 PFFS No


Clackamas Kaiser Permanente



Clackamas Kaiser Permanente



Clackamas Providence Health Assurance

Providence Medicare Extra + RX (HMO) H9047 001 HMO No



Providence Medicare Extra Part B Only + RX (HMO) H9047 013 HMO No



Providence Medicare Choice + RX (HMO-POS) H9047 024 HMOPOS No



Providence Medicare Prime + RX (HMO-POS) H9047 037 HMOPOS No


Clackamas

AgeRight Advantage Health Plan (HMO SNP)

AgeRight Advantage Health Plan (HMO SNP) (HMO SNP) H1372 001 HMO Yes Institutional










5

Clackamas FamilyCare Health

FamilyCare Community (HMO SNP) H3818 002 HMO Yes

Dual-Eligible


Clackamas CareOregon Advantage

CareOregon Advantage Plus (HMO-POS SNP) H5859 001 HMOPOS Yes

Dual-Eligible


Clackamas Health Net Health Plan of Oregon, Inc.





Providence Medicare Dual Plus (HMO SNP) H9047 043 HMO Yes

Dual-Eligible


Clatsop Providence ElderPlace Portland



Clatsop Providence ElderPlace Portland



Clatsop Moda Health Plan, Inc.


Local PPO No


Clatsop FamilyCare Health



Clatsop CareOregon Advantage



Clatsop FamilyCare Health


Dual-Eligible


Clatsop CareOregon Advantage


Dual-Eligible


6

Columbia Moda Health Plan, Inc.


Local PPO No


Columbia



Local PPO No


Columbia



Local PPO No


Columbia CareOregon Advantage



Columbia Humana Insurance Company


Local PPO No


Columbia Kaiser Permanente



Columbia Kaiser Permanente



Columbia Providence Health Assurance









Columbia CareOregon Advantage


Dual-Eligible


Coos Moda Health Plan, Inc.


Local PPO No


7

Coos



Local PPO No


Coos



Local PPO No


Coos PacificSource Medicare

PacificSource Medicare Essentials Rx 26 (HMO) H3864 026 HMO No


Coos PacificSource Medicare

PacificSource Medicare Explorer Rx 7 (PPO) H4754 007

Local PPO No


Crook Moda Health Plan, Inc.


Local PPO No


Crook PacificSource Medicare




PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) H3864 014 HMOPOS No





Crook Humana Insurance Company


Local PPO No


Crook Humana Insurance Company


Local PPO No


Crook Providence Health Assurance

Providence Medicare Latitude + RX (HMO-POS) H9047 038 HMOPOS No


8

Crook Providence Health Assurance

Providence Medicare Compass + RX (HMO-POS) H9047 039 HMOPOS No


Curry Moda Health Plan, Inc.


Local PPO No


Curry



Local PPO No


Curry



Local PPO No


Curry PacificSource Medicare



Curry PacificSource Medicare


Local PPO No


Deschutes Humana Medical Plan, Inc.



Deschutes Moda Health Plan, Inc.


Local PPO No


Deschutes PacificSource Medicare









9

Deschutes Humana Insurance Company


Local PPO No


Deschutes Humana Insurance Company


Local PPO No


Deschutes Providence Health Assurance



Deschutes Providence Health Assurance



Douglas AllCare Advantage

AllCare Advantage Gold Plus Rx (HMO) H3810 003 HMO No


Douglas Moda Health Plan, Inc.


Local PPO No


Douglas



Local PPO No


Douglas



Local PPO No


Douglas Health Net Life Insurance Company


Local PPO No




Local PPO No




Local PPO No


Douglas ATRIO Health Plans

ATRIO Silver Rx (PPO) H6743 003

Local PPO No



ATRIO Gold Rx (PPO) H6743 004

Local PPO No



ATRIO Bronze Rx (Umpqua) (PPO) H6743 007

Local PPO No


10


ATRIO Special Needs Plan (HMO SNP) H3814 007 HMO Yes

Dual-Eligible


Gilliam Moda Health Plan, Inc.


Local PPO No


Gilliam Moda Health Plan, Inc.



Grant Moda Health Plan, Inc.


Local PPO No


Grant PacificSource Medicare









Grant Moda Health Plan, Inc.



Harney Moda Health Plan, Inc.


Local PPO No


Harney Moda Health Plan, Inc.



Hood River Moda Health Plan, Inc.


Local PPO No


Hood River PacificSource Medicare



11







Hood River Humana Insurance Company


Local PPO No


Hood River Providence Health Assurance



Hood River Providence Health Assurance



Jackson AllCare Advantage



Jackson Moda Health Plan, Inc.


Local PPO No


Jackson



Local PPO No


Jackson



Local PPO No


Jackson Health Net Life Insurance Company


Local PPO No


Jackson Health Net Life Insurance Company


Local PPO No


Jackson ATRIO Health Plans

ATRIO Bronze Rx (Rogue) (PPO) H6743 014

Local PPO No


12


ATRIO Silver Rx (Rogue) (PPO) H6743 016

Local PPO No



ATRIO Gold Rx (Rogue) (PPO) H6743 017

Local PPO No



ATRIO Special Needs Plan (Rogue) (HMO SNP) H3814 029 HMO Yes

Dual-Eligible


Jackson CareOregon Advantage


Dual-Eligible


Jefferson Humana Medical Plan, Inc.



Jefferson Moda Health Plan, Inc.


Local PPO No


Jefferson PacificSource Medicare









Jefferson Humana Insurance Company


Local PPO No


Jefferson Humana Insurance Company


Local PPO No


Jefferson Providence Health Assurance



13

Jefferson Providence Health Assurance



Josephine AllCare Advantage



Josephine Moda Health Plan, Inc.


Local PPO No


Josephine



Local PPO No


Josephine



Local PPO No


Josephine Health Net Life Insurance Company


Local PPO No




Local PPO No




Local PPO No


Josephine ATRIO Health Plans

ATRIO Bronze Rx (Rogue) (PPO) H6743 014

Local PPO No



ATRIO Silver Rx (Rogue) (PPO) H6743 016

Local PPO No



ATRIO Gold Rx (Rogue) (PPO) H6743 017

Local PPO No



ATRIO Special Needs Plan (Rogue) (HMO SNP) H3814 029 HMO Yes

Dual-Eligible


Josephine CareOregon Advantage


Dual-Eligible


14

Klamath Moda Health Plan, Inc.


Local PPO No


Klamath PacificSource Medicare









Klamath ATRIO Health Plans

ATRIO Bronze Rx (Basin) (PPO) H6743 001

Local PPO No



ATRIO Silver Rx (PPO) H6743 003

Local PPO No



ATRIO Gold Rx (PPO) H6743 004

Local PPO No


Klamath





ATRIO Special Needs Plan (HMO SNP) H3814 007 HMO Yes

Dual-Eligible


Lake Moda Health Plan, Inc.


Local PPO No


Lake PacificSource Medicare



15







Lake Moda Health Plan, Inc.



Lane UnitedHealthcare


Local PPO No








Lane Moda Health Plan, Inc.


Local PPO No


Lane



Local PPO No


Lane



Local PPO No


Lane PacificSource Medicare



Lane PacificSource Medicare


Local PPO No


16

Lane Health Net Life Insurance Company


Local PPO No


Lane Health Net Life Insurance Company


Local PPO No


Lane Health Net Health Plan of Oregon, Inc.



Lane Trillium Medicare Advantage

Trillium Advantage Pioneer Rx (PPO) H6951 002

Local PPO No


Lane Providence Health Assurance










Trillium Advantage Dual (HMO SNP) H2174 001 HMO Yes

Dual-Eligible



Trillium Advantage TLC ISNP (HMO SNP) H2174 003 HMO Yes Institutional



Trillium Advantage TLC Community ISNP (HMO SNP) H2174 005 HMO Yes Institutional







UnitedHealthcare Assisted Living Plan (HMO SNP) H3113 008 HMO Yes Institutional


17

Lane Health Net Health Plan of Oregon, Inc.




Lincoln




Lincoln




Lincoln Moda Health Plan, Inc.


Local PPO No


Lincoln Humana Insurance Company


Local PPO No


Lincoln



Dual-Eligible


Linn UnitedHealthcare






Linn




Linn




Linn Moda Health Plan, Inc.


Local PPO No


Linn



Local PPO No


18

Linn



Local PPO No


Linn Health Net Life Insurance Company


Local PPO No


Linn Health Net Life Insurance Company


Local PPO No


Linn Humana Insurance Company


Local PPO No


Linn Health Net Health Plan of Oregon, Inc.



Linn Kaiser Permanente



Linn Kaiser Permanente











Linn



Dual-Eligible


Linn Health Net Health Plan of Oregon, Inc.




Malheur Moda Health Plan, Inc.


Local PPO No


Malheur Humana Insurance Company


Local PPO No


19

Malheur Humana Insurance Company


Local PPO No


Malheur Moda Health Plan, Inc.



Marion UnitedHealthcare


Local PPO No








Marion Moda Health Plan, Inc.


Local PPO No


Marion



Local PPO No


Marion



Local PPO No


Marion Health Net Life Insurance Company


Local PPO No


Marion Health Net Life Insurance Company


Local PPO No


Marion




Marion Health Net Health Plan of Oregon, Inc.



Marion ATRIO Health Plans

ATRIO Gold Rx (Willamette) (PPO) H7006 001

Local PPO No



ATRIO Silver Rx (Willamette) (PPO) H7006 003

Local PPO No


20

Marion Kaiser Permanente



Marion Kaiser Permanente



Marion Providence Health Assurance


















ATRIO Special Needs Plan (Willamette) (HMO SNP) H5995 001 HMO Yes

Dual-Eligible


Morrow Moda Health Plan, Inc.


Local PPO No


Morrow Moda Health Plan, Inc.



Multnomah Humana Medical Plan, Inc.



Multnomah UnitedHealthcare


Local PPO No


21







Multnomah Providence ElderPlace Portland



Multnomah Providence ElderPlace Portland



Multnomah Moda Health Plan, Inc.


Local PPO No


Multnomah



Local PPO No


Multnomah



Local PPO No


Multnomah FamilyCare Health



Multnomah PacificSource Medicare



Multnomah Health Net Life Insurance Company


Local PPO No


Multnomah Health Net Life Insurance Company


Local PPO No


22

Multnomah CareOregon Advantage



Multnomah




Multnomah Health Net Health Plan of Oregon, Inc.



Multnomah Humana Insurance Company



Multnomah Kaiser Permanente



Multnomah Kaiser Permanente



Multnomah Providence Health Assurance












Multnomah




23









Multnomah FamilyCare Health


Dual-Eligible


Multnomah CareOregon Advantage


Dual-Eligible


Multnomah Health Net Health Plan of Oregon, Inc.






Dual-Eligible


Polk UnitedHealthcare



Polk UnitedHealthcare



Polk Moda Health Plan, Inc.


Local PPO No


Polk



Local PPO No


Polk



Local PPO No


Polk Health Net Life Insurance Company


Local PPO No


24

Polk Health Net Life Insurance Company


Local PPO No


Polk




Polk Health Net Health Plan of Oregon, Inc.



Polk ATRIO Health Plans

ATRIO Gold Rx (Willamette) (PPO) H7006 001

Local PPO No



ATRIO Silver Rx (Willamette) (PPO) H7006 003

Local PPO No


Polk Kaiser Permanente



Polk Kaiser Permanente



Polk Providence Health Assurance










ATRIO Special Needs Plan (Willamette) (HMO SNP) H5995 001 HMO Yes

Dual-Eligible


Sherman Moda Health Plan, Inc.


Local PPO No


25

Sherman PacificSource Medicare









Sherman Moda Health Plan, Inc.



Tillamook Providence ElderPlace Portland



Tillamook Providence ElderPlace Portland



Tillamook Moda Health Plan, Inc.


Local PPO No


Tillamook CareOregon Advantage



Tillamook CareOregon Advantage


Dual-Eligible


Umatilla Moda Health Plan, Inc.


Local PPO No


Umatilla Moda Health Plan, Inc.



26

Union Moda Health Plan, Inc.


Local PPO No


Union Moda Health Plan, Inc.



Wallowa Moda Health Plan, Inc.


Local PPO No


Wallowa Moda Health Plan, Inc.



Wasco Moda Health Plan, Inc.


Local PPO No


Wasco PacificSource Medicare









Washington Humana Medical Plan, Inc.



Washington UnitedHealthcare


Local PPO No








27

Washington Providence ElderPlace Portland



Washington Providence ElderPlace Portland



Washington Moda Health Plan, Inc.


Local PPO No


Washington



Local PPO No


Washington



Local PPO No


Washington FamilyCare Health



Washington PacificSource Medicare



Washington Health Net Life Insurance Company


Local PPO No


Washington Health Net Life Insurance Company


Local PPO No


Washington CareOregon Advantage



Washington




Washington Health Net Health Plan of Oregon, Inc.



28

Washington Humana Insurance Company



Washington Kaiser Permanente



Washington Kaiser Permanente



Washington Providence Health Assurance












Washington












Washington FamilyCare Health


Dual-Eligible


29

Washington CareOregon Advantage


Dual-Eligible


Washington Health Net Health Plan of Oregon, Inc.






Dual-Eligible


Wheeler Moda Health Plan, Inc.


Local PPO No


Wheeler PacificSource Medicare









Wheeler Moda Health Plan, Inc.



Wheeler Providence Health Assurance



Wheeler Providence Health Assurance



Yamhill UnitedHealthcare


Local PPO No


30







Yamhill Moda Health Plan, Inc.


Local PPO No


Yamhill



Local PPO No


Yamhill



Local PPO No


Yamhill Health Net Life Insurance Company


Local PPO No


Yamhill Health Net Life Insurance Company


Local PPO No


Yamhill CareOregon Advantage



Yamhill Health Net Health Plan of Oregon, Inc.



Yamhill Kaiser Permanente



Yamhill Kaiser Permanente



Yamhill Providence Health Assurance



31

Yamhill












Yamhill CareOregon Advantage


Dual-Eligible


Yamhill Health Net Health Plan of Oregon, Inc.




Information Memorandum Aging and People with … 3 Part D Premium Obligation with Full Premium...

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