Pacific Source: Medicare Advantage plans: Locations, plans, and costs

PacificSource Medicare was founded in Oregon in 1933 as a not-for-profit company, offers Medicare Advantage plans, and has more than 300,000 members throughout the Northwest.

According to the Kaiser Family Foundation (KFF), Medicare-approved insurance companies, such as PacificSource, provided Advantage plans to more than 24 million US citizens in 2020.

This article looks at the PacificSource Advantage plans and availability. It also looks at the coverage, benefits, and costs.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

PacificSource offers several Medicare Advantage plans, including Health Maintenance Organization (HMO), Health Maintenance Organization Point of Service (HMO-POS), and Preferred Provider Organization (PPO).

HMO plans

PacificSource HMO plans include Medicare Essentials 2 without Part D prescription drug coverage and MyCare Rx 40 including Part D.

When a person enrolls in an HMO plan, they agree to use the plan’s network of healthcare providers. They also choose a primary care doctor from within the network, who then coordinates health services and referrals to specialists.

If a person wants to use a healthcare provider from outside the network, they may have more costs, except in a medical emergency.

Medicare Essentials 2 (HMO) plan

This plan is available in certain counties in Oregon. In 2021, the monthly premium and the annual deductible are both zero, while the out-of-pocket maximum expense is $5,500. A person must use in-network providers.

My Care Rx 40 (HMO) plan

This plan is available in certain counties in Oregon.
The monthly premium in 2021 is zero. Out-of-pocket expenses in 2021 have an annual maximum of $4,950, and a person must use in-network providers.

HMO-POS plans

PacificSource HMO-POS plans include Medicare Essentials Choice Rx 14, and MyCare Choice Rx 24, both of which include prescription drugs (Part D) coverage.

With HMO-POS plans, people have the freedom to use healthcare services outside of their plan’s network. However, they must pay a higher copay or coinsurance to do so.

Medicare Essentials Choice Rx 14 plan (HMO-POS) plan

This plan is available in certain counties in Oregon.
In 2021, the monthly premium is $99.00 and the in-network out-of-pocket maximum is $5,500.

2021 MyCare Choice Rx 24 (HMO-POS) plan

This plan is available in certain counties in Idaho.
The monthly premium in 2021 is $35. Out-of-pocket expenses have an annual maximum of $5,500 in 2021 for in-network providers and no maximum for out-of-network services.

PPO plans

PacificSource PPO plans include Explorer 12 without the prescription drug (Part D) cover and Explorer Rx4, including Part D prescription drug coverage.

These

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