Compare Our 2020 Plans

Three Plans That Fit Your Needs

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 you healthy.

All Samaritan Advantage plans offer:

$0 medical deductible
$3,750 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

Optional benefits include prescription drugs, preventive and comprehensive dental, a SamFit gym membership, hearing aids and more!

New! Lower Copays & a Reduced Premium

One of our plans with prescription drug coverage — our Premier Plan (HMO) — has a much lower premium for 2020. And both of our plans with prescription drugs feature lower copays for doctor and specialist visits.

Medical and Prescription Drug Plans Medical and Rx
Medical Only Plan Medical Only

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	$55 / month	$129 / month
Deductible	$0 annual deductible	Same as Premier Plan
Medical Out-Of-Pocket Maximum	$3,750 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	Same as Premier Plan
Inpatient Hospital Care	$300 copay per day for days 1–6 $0 copay per day for days 7–90	Same as Premier Plan
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 hours)	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 $160 copay per day for days 21–60 $0 copay per day for days 61–120	Same as Premier Plan
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
Gym Membership	Not available with this plan	$0 gym membership to SamFit
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: 46% coinsurance 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: 50% coinsurance for non-preferred brand drugs 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 $4,020 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 $6,350, you enter the Catastrophic Coverage Phase.)	The greater of $3.60 copay (generics), $8.95 copay (brands) or 5% coinsurance	Same as Premier Plan

Most Medicare drugs are covered; mail order service available; 1-3 month supply available.

Members with Premier Plan coverage who are receiving Extra Help from Medicare will have an $89 deductible for Tiers 3, 4 and 5. For more detailed benefit information, review the plan documents.

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	$3,750 is the most you will pay per year for medical copays and coinsurance that apply to your out-of-pocket max
Doctor Office Visits	$5 copay per primary care visit $20 copay per specialist visit
Inpatient Hospital Care	$200 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 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 $160 copay per day for days 21–60 $0 copay per day for days 61–120
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)
Gym Membership	$0 gym membership to SamFit

For more detailed benefit information, review the plan documents.

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Page updated 10/1/2019