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2013 Trillium Advantage Rx Smart HMO

A Plan With Prescription Drug Coverage

If you live in Lane County and are looking for a more affordable Medicare Advantage plan, pick Trillium Advantage Rx Smart.
You will receive substantial coverage for medical expenses and protection for potential prescription costs.
There are no limitations based on age and the price is right.


Trillium Flower

Attend a Meeting
Seminar Schedule


Ready to enroll?
Enroll Online Now
or download an enrollment form and mail it to Trillium: 2014


If you do not prefer drug coverage, pick
Trillium Advantage HMO


Directories:

Pharmacy Directory

Provider Directory

Benefit Highlights

  • No deductibles
  • No referrals
  • No Primary Care Provider (PCP) requirements
  • Limited out-of-pocket costs
  • Low or no co-pays for doctor and specialists' visits
  • Access to over 1,400 Lane County physicians
  • Access to worldwide emergency care when you travel
  • Friendly, responsive customer service
  • Prescription coverage through the coverage gap
  • Access to all pharmacies in Lane County
  • A convenient pharmacy mail-order service
  • Coverage for over 3,200 brand name and generic drugs.
    Our prescription drug benefits cover more than Medicare requires and gives extra
    protection against higher out-of-pocket costs.
  • Coverage for preventive services and screenings (including HIV Screenings)

Plan Specific Documents


Trillium Advantage Rx Smart HMO Overview Chart

Monthly Premium $49
Provider Office $15 co-pay
Specialist Visit (no referrals required) $25 co-pay
X-Ray & Lab $0-15 co-pay
Preventive Services $0 co-pay
Inpatient Hospital Days 1-7: $300/day
Days 8-90: $0/day
Outpatient Surgery 15%
Skilled Nursing Facility Days 1-20: $0/day
Days 21-100: $100/day
Emergency Room (worldwide service) $65
Urgent Care (worldwide service) $40 co-pay
Out-of-Pocket Maximum $3,400
Prescription Drugs Phase I - Initial Coverage:
$0 deductible
Tier 1 generic drugs: $8 for 1 month or $24 for 3 months
Tier 2 brand name: $45 a month $135 for 3 months
Tier 3 non-preferred: $80 a month $240 for 3 months
Tier 4 33% specialty drugs
Phase II - Coverage Gap:
Phase II begins when total drug costs reach $2,970
21% discount generic
52.5% discount brand
Phase III - Catastrophic:
Phase III begins when out-of-pocket drug costs reach $4,750
$2.60 for generic drugs
$6.50 or 5% coinsurance for all other drugs.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

National Committee for Quality Assurance (NCQA)
Contact us toll free: (800) 910-3906  TTY: (866) 279-9750 
Trillium Member Services is available to answer your call directly during the following times:
October 1st through February 14th from 8 a.m. to 8 p.m., Monday through Sunday and
February 15th through September 30th from 8 a.m. to 8 p.m., Monday through Friday (except on holidays). Our automated system is available anytime for self-service options, including after hours, weekends, and holidays. Member Services also has free language interpreter service available for non-English speakers.






Serving Eugene, Springfield and all of Lane County - UO Riverfront Research Park 1800 Millrace Drive Eugene, Oregon

Trillium Community Health Plan ® is an HMO and PPO health plan with a Medicare and Oregon Medicaid contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and / or co-payments / co-insurance may change on January 1 of each year.

You must continue to pay your Medicare Part B premium. For full dual members the part B premium is covered by the state. The Dual SNP plan is available to anyone who has both Medical Assistance from the state and Medicare. The ISNP plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home. The Community ISNP plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a community. Trillium Community Health Plan has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 2016 based on a review of Trillium Advantage Dual SNP, Trillium Advantage ISNP, and Trillium Advantage TLC ISNP’s Model of Care. Premiums, co-pays, co-insurance and deductibles may vary on the level of Extra Help you receive. Please contact the plan for further details. A sales person will be present with information and applications. For accommodations of persons with special needs at sales meetings, call 1(800) 910-3906 or TTY 1(866) 279-9750.

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

Current Trillium star ratings can be downloaded by year when avalible: 2014 | 2015

Enrollment in Trillium Advantage depends on contract renewal. Medicare beneficiaries may also enroll in Trillium Advantage plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov. This information is available for free in other languages. Please call our customer service number at 1(800) 910-3906 or TTY 1(866) 279-9750.

This information is available for free in other languages. Please call our customer service number at 1-800-910-3906.

Y0101_AD03V39 Status Pending  |  Last Updated: October 17 2014.