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2021 Medicare Advantage Plans
Samaritan Health Plans is the only locally-managed Medicare provider serving Benton, Lincoln and Linn counties. We’re proud to offer a range of benefits designed to keep our members healthy.
All Samaritan Advantage plans offer:
- $0 medical deductible
- $4,600 out-of-pocket maximum
- Access to our extensive network of Oregon doctors and hospitals
- 24/7 Nurse Advice Line
- Coverage for acupuncture, chiropractic, skilled nursing facility services, worldwide emergency care, eyewear and more
Plus, choose from other benefits including prescription drugs, preventive and comprehensive dental, Silver&Fit or a SamFit gym membership, hearing aids and more!
Looking for Enrollment Materials and Plan Documents?
Overview of Plan Benefits
We offer two plans for those wanting both medical and prescription drug coverage — Premier Plan (HMO) and Premier Plan Plus (HMO).
| Premier Plan (HMO) | Premier Plan Plus (HMO) | |
|---|---|---|
| Premium | $35 / month | $129 / month |
| Deductible | $0 annual deductible | Same as Premier Plan |
| Medical Out-Of-Pocket Maximum | $4,600 is the most you will pay per year for medical copays and coinsurance that apply to your out-of-pocket max | Same as Premier Plan |
| Doctor Office Visits | $5 copay per primary care visit $30 copay per specialist visit |
$10 copay per primary care visit $30 copay per specialist visit |
| Inpatient Hospital Care | $350 copay per day for days 1–5 $0 copay per day for days 6–90 |
$325 copay per day for days 1–5 $0 copay per day for days 6–90 |
| Urgent Care — Nationwide | $35 copay per urgent care visit | Same as Premier Plan |
| Emergency Care — Worldwide | $90 copay per emergency care visit ($0 copay if you are admitted to the hospital within 12 to 24hours) |
Same as Premier Plan |
| Ambulance | $250 copay per one-way trip by ground | Same as Premier Plan |
| Air Ambulance | 20% coinsurance | Same as Premier Plan |
| Skilled Nursing Facility Care | $0 copay per day for days 1–20 $165 copay per day for days 21–45 $0 copay per day for days 46–100 |
$0 copay per day for days 1–20 $160 copay per day for days 21–60 $0 copay per day for days 61–100 |
| Chiropractic | $20 copay per visit for manual manipulation
of the spine to correct subluxation $25 copay per visit for routine chiropractic with up to 5 visits per year |
Same as Premier Plan |
| Acupuncture | $20 copay per acupuncture visit with up to 30 visits per year | Same as Premier Plan |
| Annual Physical Exams | $0 copay per exam | Same as Premier Plan |
| Outpatient Hospital Services | $200 copay per outpatient surgery | 15% coinsurance per outpatient surgery |
| Fitness Benefit | Silver&Fit optional with additional fee or $0 SamFit gym membership | Silver&Fit included in plan premium |
| Vision Services | $30 copay per visit for exams to diagnose and
treat conditions and diseases of the eye $0 copay per visit for routine eye exam (1 per year) $125 limit per calendar year for eyewear |
$30 copay per visit for exams to diagnose and
treat conditions and diseases of the eye $30 copay per visit for routine eye exam (1 per year) $125 limit per calendar year for eyewear |
| Dental Services | Not available with this plan | $25 copay per preventive visit (up to 2 oral
exams and 2 regular cleanings per year) $0 copay for dental X-rays (1 set per calendar year) $1,000 limit per calendar year for comprehensive dental services such as crowns, fillings and extractions |
| Hearing Aids and Equipment | Not available with this plan | $500 limit per calendar year for hearing aids and equipment |
Part D Prescription Drug Coverage
| Premier Plan (HMO) | Premier Plan Plus (HMO) | |
|---|---|---|
| Annual Deductible Phase | $200 (only applies to Tiers 3, 4 and 5) | $0 |
| Initial Coverage Phase (You begin the calendar year paying these cost shares.) |
Tier 1: Maximum $3 copay Tier 2: Maximum $9 copay for generic formulary drugs Tier 3: Maximum $47 copay for preferred brand drugs Tier 4: Maximum $100 copay for non-preferred brand drugs Tier 5: 29% coinsurance for specialty drugs Tier 6: $0 copay Select Care Drugs |
Tier 1: Same as Premier Plan Tier 2: Same as Premier Plan Tier 3: Same as Premier Plan Tier 4: Same as Premier Plan Tier 5: 33% coinsurance for specialty drugs Tier 6: Same as Premier Plan |
| Coverage Gap Phase (If you and the Plan pay a combined yearly total of $4,130 for prescription drugs, you enter the Coverage Gap Phase.) |
25% coinsurance for generic drugs 25% coinsurance for brand drugs |
No more than $9 copay for generic drugs 25% coinsurance for brand drugs |
| Catastrophic Phase (If your out-of-pocket costs and the amount discounted by brand drug manufacturers total $6,550, you enter the Catastrophic Coverage Phase.) |
The greater of $3.70 copay (generics), $9.20 copay (brands) or 5% coinsurance | Same as Premier Plan |
Most Medicare drugs are covered; mail order service available; 1-3 month supply available.
For those wanting the additional medical benefits of an Advantage plan without the Part D prescription drug benefit, we offer our Conventional Plan (HMO).
| Conventional Plan (HMO) | |
|---|---|
| Premium | $70 / month |
| Deductible | $0 annual deductible |
| Medical Out-Of-Pocket Maximum | $4,600 is the most you will pay per year for medical copays and coinsurance that apply to your out-of-pocket max |
| Doctor Office Visits | $10 copay per primary care visit $20 copay per specialist visit |
| Inpatient Hospital Care | $350 copay per day for days 1–5 $0 copay after day 5 |
| Urgent Care — Nationwide | $25 copay per urgent care visit |
| Emergency Care — Worldwide | $90 copay per emergency care visit ($0 copay if you are admitted to the hospital within 12 to 24 hours) |
| Ambulance | $250 copay per one-way trip by ground |
| Air Ambulance | 20% coinsurance |
| Outpatient Hospital Services | $150 copay per outpatient surgery |
| Skilled Nursing Facility Care | $0 copay per day for days 1–20 $165 copay per day for days 21–45 $0 copay per day for days 46–100 |
| Vision Services | $20 copay per visit for exams to diagnose and
treat conditions and diseases of the eye $20 copay per visit for routine eye exam (1 per year) $125 limit per calendar year for eyewear |
| Chiropractic | $20 copay per visit for manual manipulation
of the spine to correct subluxation $25 copay per visit for routine chiropractic with up to 5 visits per year |
| Acupuncture | $20 copay per acupuncture visit with up to 30 visits per year |
| Annual Physical Exams | $0 copay per exam |
| Preventive Dental | $20 copay per preventive visit (up to 2 oral
exams and 2 regular cleanings per year) $0 copay for dental X-rays (1 set per calendar year) |
| Fitness Benefit | $0 gym membership to SamFit |
Background image: Samaritan employees working out at SamFit
Partner with Oregon’s Healthiest Employer
For seven out of the past eight years, Samaritan has been named Oregon’s Healthiest Employer in the 1500+ employee category by Portland Business Journal. With its own self-insured plan, Samaritan has achieved a return on investment through a commitment to workplace wellness.
As the state’s healthiest employer, Samaritan is inviting Oregon businesses to join a health plan with an award-winning formula for healthier employees and lower costs.