at a glance
- PacificSource offers HMO, HMO-POS, and PPO Medicare Advantage plans in Oregon and Idaho.
- PacificSource plans include extra coverage for fitness, hearing, vision, and more.
- Many PacificSource plans include prescription drug coverage, and some come with no monthly premium.
- PacificSource was founded in 1933 and serves more than 500,000 members throughout its coverage area.
PacificSource is a healthcare company first founded in Eugene, Oregon, as Pacific Hospital Association in 1933. The company has grown over its years of operation to offer service throughout Oregon and its neighboring state of Idaho.
As a Medicare Advantage provider, PacificSource serves Oregon and Idaho. Medicare Advantage plans are available as HMOs, HMO-POSs, and PPOs. PacificSource offers affordable plans across its service area, including options with no premiums.
PacificSource HMO plans
An HMO is a type of health insurance plan that works with a network of providers. You’ll need to stay within your plan’s network for your healthcare services to be covered.
If you choose to see a doctor or other provider outside the network, your service probably won’t be covered. However, if you’re having a medical emergency and need care, an HMO will cover your care even if you go out of network.
You might also need to have a referral from your primary care provider (PCP) before your plan will cover specialist visits. You’ll need to designate a PCP and see them first before you make any appointments with specialists. If you skip this step, your HMO plan might not cover your service, even if the specialist is in your network.
PacificSource HMO-POS plans
Some of PacificSource’s HMO plans are HMO Point-of-Service (HMO-POS) plans. With an HMO-POS, you’ll be able to see some out-of-network providers in certain circumstances. However, you’ll pay a significantly higher copay cost than you would if you stayed in your plan’s network.
PacificSource PPO plans
PPO plans also have a network. As with an HMO-POS, you can go outside your network with your PPO and pay a higher out-of-pocket cost.
Unlike an HMO or HMO-POS, you won’t need to designate a PCP or get specialist referrals. That means that with a PPO, you can make direct appointments with a specialist.
PacificSource offers Medicare Advantage plans both with and without Medicare Part D (prescription drug) coverage. However, PacificSource doesn’t offer separate Part D plans.
You’ll need to purchase a Medicare Advantage plan with Part D coverage included to get prescription drug coverage from PacificSource.
Search your ZIP code on Medicare’s plan finder tool to see if PacificSource offers plans in your county and how much they will cost.
PacificSource Medicare Advantage plans cover many of your healthcare needs. You’ll be covered for all the services that original Medicare provides, plus some additional services.
Some services are only covered with certain plans. For example, not all PacificSource plans include Part D coverage.
However, some standard services are covered across PacificSource plans, including:
- fitness services or gym membership
- reimbursement for certain over-the-counter medications
- routine vision care
- up to $200 reimbursement toward glasses or contacts every 2 years
- low-cost hearing exams
- covered hearing aid purchases up to a set amount
- access to a 24/7 health phone line staffed by nurses
- emergency medical coverage while you’re away from home
- optional add-on dental coverage
Here are examples of what you may expect to pay for various PacificSource Medicare Advantage plans in Idaho and Oregon.
|City/plan||Monthly premium||Deductible||PCP |
|Twin Falls, ID:|
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS)
|$35||$0 (health) $100 (drug)||$0||$0–$34||$4,900 in network|
PacificSource Medicare MyCare Rx 32 (HMO)
|$0||$0–$39||$5,150 in network|
|Idaho Falls, ID: PacificSource Medicare Explorer Rx 9 (PPO)||$99||$0 (health)|
|$0–$10||$0–$35||$6,300 in network, $10,000 in and out of network|
PacificSource Medicare MyCare Rx 40 (HMO)
|$0||$0–$30||$4,950 in network|
PacificSource Medicare Explorer Rx 4 (PPO)
|$109||$0 (health) |
|$0–$10||$0–$35||$5,500 in network, $10,000 in and out of network|
Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) together are often called original Medicare. Medicare Part C (Medicare Advantage) combines the coverage of Medicare parts A and B into one plan.
Medicare Advantage plans are offered by private insurance companies through an agreement with Medicare. Plans are required to cover all the same services as original Medicare. These include:
- PCP visits
- specialist visits
- physical, occupational, and speech therapy
- preventative care
- hospital stays
- home healthcare
- limited skilled nursing facility care
- emergency ambulance transportation
- home medical equipment
Many Medicare Advantage plans offer additional services that original Medicare doesn’t cover, such as Part D, vision care, and dental care.
With a Medicare Advantage plan, you’ll pay any monthly costs for the plan, plus your Part B premium.
The plans available to you will depend on where you live. Plans are specific to states, regions, counties, and, sometimes even cities.
You can check out what’s available in your area on the Medicare plan finder tool.
- PacificSource offers Medicare Advantage plans to residents of Oregon and Idaho.
- Available plans include HMO, HMO-POS, and PPO options.
- The plans available to you will depend on your county, but in many regions, plans without monthly premiums are available.
- PacificSource plans cover all the services of original Medicare plus extras like routine vision care, hearing exams, over-the-counter medication reimbursement, and fitness memberships.