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PacificSource Medicare Essentials Choice Rx 14 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Medicare Essentials Choice Rx 14 (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 Rx 14 (HMO-POS) in 2026, please refer to our full plan details page.
PacificSource Medicare Essentials Choice Rx 14 (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 2026.
It's important to know that PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) 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 Choice Rx 14 (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 Rx 14 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $104.00. 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 $199.00 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 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
The PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) plan features an annual drug deductible of $199. Under this plan, Tier 1 preferred generic drugs have no copay for up to a three-month supply at both standard pharmacies and standard mail order. Tier 2 generic drugs require a $10 copay for a one-month supply at standard pharmacies, while standard mail order offers a flat $10 copay for one, two, or three-month supplies. For Tier 3 preferred brand drugs, you will pay a 24% coinsurance at standard pharmacies or a lower 15% coinsurance through standard mail order. Tier 4 non-preferred drugs carry a 28% coinsurance, and Tier 5 specialty drugs require a 30% coinsurance for a one-month supply across both standard pharmacies and mail order options.
Additional Benefits
The PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) plan features affordable medical coverage with no copay and no coinsurance for primary care visits, home health services, and annual physicals. For emergency care, members pay a $120 copay, while inpatient hospital stays require daily copays for the first few days before transitioning to no copay. Outpatient hospital services and specialist visits are also covered with no coinsurance and copays ranging from no copay up to $375. This plan also provides excellent supplemental benefits, including routine vision exams and eyewear with no copay, no deductible, and no coinsurance. Preventive dental services feature no copay up to a $1,500 annual limit, while routine hearing exams require a $25 copay. For durable medical equipment and dialysis services, members will pay no copay and a 20% coinsurance.
Inpatient Hospital See details
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) partially covers inpatient hospital services with no coinsurance, subject to prior authorization. Acute care requires a $375 daily copay for days 1 to 7 and no copay for days 8 and beyond, while psychiatric care requires a $275 daily copay for days 1 to 6 and no copay for days 7 to 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) feature no coinsurance, with outpatient hospital copays ranging from $0 to $375 and observation services costing a $375 copay per stay. Ambulatory surgical center and blood services require no copay or coinsurance, though prior authorization is needed for outpatient hospital and surgical center visits. Outpatient substance abuse individual and group sessions are covered with a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) with a $35 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Additional transportation services, including travel to plan-approved or any health-related locations, are not covered.
Emergency Services See details
Emergency services under PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) are covered with a $120 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 72 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays of $120, $50, and $300, respectively, with no coinsurance.
Primary Care See details
Primary care benefits under PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) feature no copay and no coinsurance for primary care provider visits. Specialist visits, mental health, and therapy services require copays ranging from $0 to $35 with no coinsurance, while chiropractic services are partially covered (excluding other chiropractic services) and podiatry is not covered.
Preventive Services See details
Preventive services are partially covered by PacificSource Medicare Essentials Choice Rx 14 (HMO-POS), featuring no copay and no coinsurance for annual physicals, glaucoma screenings, and diabetes training. While kidney disease education has no copay but carries a 20% coinsurance, several sub-services such as health education, medical nutrition therapy, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by PacificSource Medicare Essentials Choice Rx 14 (HMO-POS), which offers one routine hearing exam annually for a $25 copay and no coinsurance. Up to two prescription hearing aids per year are covered with no coinsurance and a copay ranging from $599 to $999, but OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision Services are covered by PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) with no copay, no coinsurance, and no deductible for eye exams and eyewear. This partially covered benefit includes one routine eye exam every year and a $200 combined maximum allowance for contact lenses and eyeglasses every two years, though eyewear upgrades are not covered.
Dental Services See details
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) offers partially covered dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental care and no copay or coinsurance for preventive services up to a $1,500 annual maximum. Comprehensive dental benefits like implants and endodontics require no copay and 50% coinsurance, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) covers home infusion bundled services with no copay, although prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance of no coinsurance to 20%, while Part B insulin drugs require a $35 copay and a coinsurance of no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) covers durable medical equipment and medical supplies with no copay and 20% coinsurance, and prosthetic devices with no copay and coinsurance ranging from no coinsurance to 20%. Diabetic equipment is covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) covers diagnostic and radiological services with prior authorization, requiring a $15 copay and 20% coinsurance for diagnostic tests. Lab and outpatient X-ray services have no copay and 20% coinsurance, diagnostic radiological services have no copay, and therapeutic radiological services require both a copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) covers some cardiac rehabilitation services with no copay and no coinsurance. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $203 daily copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) covers annual wellness visits and over-the-counter items up to twenty-five dollars every three months with no copay or coinsurance, as well as acupuncture for a twenty-five dollar copay and no coinsurance up to twelve treatments per year. Meal benefits and nicotine replacement therapy are not covered.
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