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PacificSource Medicare Essentials Rx 6 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Medicare Essentials Rx 6 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PacificSource Medicare Essentials Rx 6 (HMO) in 2026, please refer to our full plan details page.
PacificSource Medicare Essentials Rx 6 (HMO) is a HMO 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 2026.
It's important to know that PacificSource Medicare Essentials Rx 6 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PacificSource Medicare Essentials Rx 6 (HMO).
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 Rx 6 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $223.00. 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.
This plan has a $99.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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
The PacificSource Medicare Essentials Rx 6 (HMO) plan features an affordable $99 annual drug deductible for its prescription drug coverage. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs whether filled at standard pharmacies or through standard mail order. For Tier 2 generic drugs, copays start at $12 for a one-month supply at standard pharmacies, with standard mail order offering a flat $12 copay for one, two, or three-month supplies. Higher-tier medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brand drugs require a 24% coinsurance at standard pharmacies, which drops to a lower 15% coinsurance through standard mail order. Tier 4 non-preferred drugs carry a 28% coinsurance, while Tier 5 specialty drugs require a 31% coinsurance for a one-month supply.
Additional Benefits
The PacificSource Medicare Essentials Rx 6 (HMO) plan provides coverage with no copay and no coinsurance for primary care visits, preventive screenings, and home health services. Specialist visits require no copay to a $15 copay, while inpatient hospital stays require a $350 copay for the first seven days followed by no copay. Emergency care is covered with a $120 copay, which is waived if you are admitted, and urgent care visits require a $50 copay. For supplemental care, the plan includes dental benefits up to a $1,250 annual limit with no copay for preventive services and a 50% coinsurance for comprehensive care. Vision services feature no copay or deductible, offering a routine eye exam and a $200 eyewear allowance every two years. Additionally, routine hearing exams require a $25 copay, and prescription hearing aids are covered with copays ranging from $599 to $999.
Inpatient Hospital See details
PacificSource Medicare Essentials Rx 6 (HMO) covers inpatient hospital services with no coinsurance, although prior authorization is required and upgrades or non-Medicare-covered stays are not covered. For acute care, you pay a $350 copay for days 1 to 7 and no copay for days 8 and beyond, while psychiatric stays cost a $275 copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
PacificSource Medicare Essentials Rx 6 (HMO) covers outpatient hospital services with a $0 to $275 copay and observation services with a $275 copay per stay, both with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the PacificSource Medicare Essentials Rx 6 (HMO) plan with a $30.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
PacificSource Medicare Essentials Rx 6 (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
PacificSource Medicare Essentials Rx 6 (HMO) covers emergency services with a $120 copay—waived if admitted to the hospital within 72 hours—and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $120, $50, and $250, respectively.
Primary Care See details
PacificSource Medicare Essentials Rx 6 (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $15 copay and no coinsurance. Therapy, mental health, and psychiatric services require copays of $15 to $20 with no coinsurance, while chiropractic care is partially covered with a $25 copay for routine care, and podiatry services are not covered.
Preventive Services See details
Preventive services under PacificSource Medicare Essentials Rx 6 (HMO) are partially covered, featuring annual physicals and screenings with no copay and no coinsurance, and kidney disease education with no copay and 20% coinsurance. Alternative therapies are covered with a $25 copay and no coinsurance for up to 18 visits, and fitness benefits are included with no coinsurance. However, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, safety devices, and counseling.
Hearing Services See details
PacificSource Medicare Essentials Rx 6 (HMO) hearing services are partially covered, offering routine hearing exams for a $25 copay and no coinsurance, alongside hearing aid fittings with no coinsurance. Prescription hearing aids are covered with a $599 to $999 copay and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
PacificSource Medicare Essentials Rx 6 (HMO) partially covers vision services with no copay, no coinsurance, and no deductible, although eyewear upgrades are not covered. This benefit includes one routine eye exam and up to a $200 combined maximum limit for contacts and eyeglasses every two years.
Dental Services See details
PacificSource Medicare Essentials Rx 6 (HMO) dental services are partially covered up to a $1,250 annual limit, though maxillofacial prosthetics and orthodontics are not covered. Medicare-covered dental services require a $25 copay and no coinsurance, preventive services have no copay and no coinsurance, and comprehensive services require no copay and 50% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the PacificSource Medicare Essentials Rx 6 (HMO) plan with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by PacificSource Medicare Essentials Rx 6 (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
PacificSource Medicare Essentials Rx 6 (HMO) covers medical equipment with no copays, requiring a 20% coinsurance for durable medical equipment and medical supplies, and 0% to 20% coinsurance for prosthetic devices. Diabetic equipment is covered with no coinsurance, but this benefit is only partially covered because diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PacificSource Medicare Essentials Rx 6 (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures require a $15 copay and 20% coinsurance, lab services and outpatient x-rays have no copay and 20% coinsurance, and diagnostic radiological services feature no copay and no coinsurance.
Home Health Services See details
PacificSource Medicare Essentials Rx 6 (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by PacificSource Medicare Essentials Rx 6 (HMO) with no coinsurance, though copayments may apply. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PacificSource Medicare Essentials Rx 6 (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $203 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by PacificSource Medicare Essentials Rx 6 (HMO), including acupuncture with a $25 copay and no coinsurance for up to 18 treatments yearly, and annual wellness visits with no copay and no coinsurance. Over-the-counter items are covered with no copay and no coinsurance up to a $25 limit every three months, excluding nicotine replacement therapy, while meal benefits are not covered.
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