2012 plans

Our 2012 plans

Samaritan Advantage Health Plan HMO offers four plans:

  • Conventional Plan – generous medical benefits with an affordable premium and low co-pays; does not include Medicare Part D prescription drug coverage
  • Premier Plan – all the medical benefits of the Conventional Plan, plus Medicare Part D prescription drug coverage
  • Premier Plan Plus – all the medical benefits and pharmacy benefits of the Premier Plan, plus dental benefits, coverage for generic drugs through the Coverage Gap, hearing aid benefit and out-of-pocket maximum for durable medical equipment.
  • Special Needs Plan – this plan is designed for people who meet specific enrollment criteria. You may be eligible to join this plan if you receive assistance from the state and Medicare. Contact Customer Service for more information at (541) 768-4550, 1-800-832-4580 (TTY 1-800-735-2900) from 8 a.m. to 8 p.m.

While you are a member of any of our plans, you must use our Plan providers to get your covered services. We list the providers that participate with Samaritan Advantage Health Plan HMO in our Provider Directory. Some coverage is available when you travel out of the area. See your Evidence of Coverage for additional information.

IF YOU NEED:

CONVENTIONAL PLAN
$67/month*

PREMIER PLAN
$99/month*

PREMIER PLAN PLUS
$121/month*

Medical benefits only

This is the plan for you

 

 

Medical benefits w/prescription drug coverage

 

This is the plan for you

 

Medical benefits w/prescription drug coverage including coverage in the gap, plus dental and hearing aid benefits, and out-of-pocket maximum for durable medical equipment

 

 

This is the plan for you

See also: Summary of Benefits and Evidence of Coverage

Last modified: October 24, 2012
H3811_MA4001_2012A CMS Approved October 24, 2012

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Tell your Samaritan story | Contact Us | Terms of Use | Patient privacy
Samaritan Advantage Health Plan HMO is a coordinated care plan with a Medicare Advantage Contract and a contract with the Oregon Medicaid program. Individuals must have both Part A and Part B to enroll. Members may enroll in the Conventional, Premier, and Premier Plus plans only during specific times of the year. You must continue to pay your Medicare Part A and Part B premiums. You must receive all routine care from plan providers. Benefits, formulary, pharmacy network, premium, and/or co-payments/coinsurance may change on January 1 of each year. The benefit information provided is a brief summary, not a complete description of benefits. Limitations, co-payments and restrictions may apply. Other providers are available in our network. For more information, contact Samaritan Advantage Health Plan.

Other Medicare Links: By clicking on any of the following links, you will be leaving the Samaritan Health Plan website.
Centers for Medicare and Medicaid Services (CMS) at www.cms.hhs.gov Medicare at www.medicare.gov | The Office of the Medicare Ombudsman (OMO) at www.medicare.gov/navigation/help-and-support/ombudsman.aspx for assistance with complaints, grievances, and information requests | Medicare Complaint Form at www.medicare.gov/MedicareComplaintForm/home.aspx to submit feedback about your Medicare health plan or prescription drug plan directly to Medicare using this form | Social Security Administration (SSA) at www.ssa.gov
© 2012 Samaritan Health Services