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PacificSource Medicare Essentials Choice 2 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Medicare Essentials Choice 2 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PacificSource Medicare Essentials Choice 2 (HMO-POS) in 2025, please refer to our full plan details page.
PacificSource Medicare Essentials Choice 2 (HMO-POS) is a HMO-POS plan offered by PacificSource available for enrollment in 2025 to people living in Select Oregon Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that PacificSource Medicare Essentials Choice 2 (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PacificSource Medicare Essentials Choice 2 (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For PacificSource Medicare Essentials Choice 2 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
Prescription drugs are not covered by PacificSource Medicare Essentials Choice 2 (HMO-POS).
Additional Benefits
The PacificSource Medicare Essentials Choice 2 (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and coverage for emergency and primary care services with copays. Preventive services like annual physical exams have no copay, and the plan also covers hearing, vision, and dental services with specific copays, coinsurance, and maximum benefit amounts. Additional benefits include home health services with no copay, medical equipment with coinsurance, and coverage for dialysis services with 20% coinsurance. The plan also covers ambulance services with a $300 copay and offers coverage for other services like acupuncture and over-the-counter items with copays and benefit limits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $425 copay for days 1-7 and no copay for days 8-90, while Inpatient Hospital Psychiatric has a $230 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, however Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and observation services, are covered by the PacificSource Medicare Essentials Choice 2 (HMO-POS) plan. Outpatient hospital services have a copay of $0.00 - $425.00, while observation services have a copay of $425.00. Ambulatory Surgical Center (ASC) Services are covered with no copay, and outpatient substance abuse services and outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the PacificSource Medicare Essentials Choice 2 (HMO-POS) plan, with a copay of $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the PacificSource Medicare Essentials Choice 2 (HMO-POS) plan. Ground and air ambulance services have a $300 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the PacificSource Medicare Essentials Choice 2 (HMO-POS) plan. Emergency Services have a $120 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
Primary Care, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services and Additional Telehealth Benefits have a copay between $0 and $10, Chiropractic Services has a $10 copay, Physician Specialist Services has a $10 copay, Occupational Therapy Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, and Physical Therapy and Speech-Language Pathology Services have a $10 copay, and there is no coinsurance for any of these services. Podiatry Services are not covered.
Preventive Services See details
The PacificSource Medicare Essentials Choice 2 (HMO-POS) plan covers preventive services, including annual physical exams, with no copay. The plan also covers alternative therapies with a $10 copay. Kidney disease education services are covered with 20% coinsurance.
Hearing Services See details
Hearing services include routine hearing exams with a $40 copay and fitting/evaluation for hearing aids with no copay, both covered annually. Prescription hearing aids are covered with a copay between $599 and $999, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams and other eye exam services. Eyewear is covered with a combined maximum of $200 every two years, and contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames are also covered, but upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $40 copay, and a $1,000 maximum benefit per year, as well as other dental services including oral exams, dental x-rays, and other diagnostic and preventive services with no cost sharing. Restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered with 50% coinsurance, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, all with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the PacificSource Medicare Essentials Choice 2 (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetic Devices with a 0-20% coinsurance and no copay, and Medical Supplies with a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a minimum copay of $15 and a maximum coinsurance of 20%, lab services with a maximum coinsurance of 20%, diagnostic radiological services with a maximum copay of $400, and therapeutic radiological services with a minimum coinsurance of 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for the covered services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PacificSource Medicare Essentials Choice 2 (HMO-POS) plan. There is no copay for days 1-20, and a $203 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The "Other Services" benefit covers acupuncture with a $10 copay, and over-the-counter (OTC) items, including Naloxone, with a maximum benefit coverage amount of $50 every three months. The plan does not cover the meal benefit, and many additional services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
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