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PacificSource Medicare MyCare Choice Rx 24 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Medicare MyCare Choice Rx 24 (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 MyCare Choice Rx 24 (HMO-POS) in 2026, please refer to our full plan details page.
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) is a HMO-POS plan offered by PacificSource available for enrollment in 2025 to people living in Select Idaho Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that PacificSource Medicare MyCare Choice Rx 24 (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 MyCare Choice Rx 24 (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 MyCare Choice Rx 24 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $57.00. 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 $499.00 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 MyCare Choice Rx 24 (HMO-POS) plan features an annual drug deductible of $499. Under this prescription drug plan, Tier 1 preferred generic drugs have no copay for up to a three-month supply through standard pharmacies and standard mail order. Tier 2 generic drugs require a $6 copay for a one-month supply at standard pharmacies, while standard mail order offers a flat $6 copay for one, two, or three-month supplies. For higher-tier medications, Tier 3 preferred brand drugs require a 20% coinsurance at standard pharmacies and a 15% coinsurance through standard mail order. Tier 4 non-preferred drugs carry a 25% coinsurance for both standard pharmacy and standard mail order fills. Tier 5 specialty drugs are subject to a 27% coinsurance for a one-month supply through both standard pharmacy and standard mail order channels.
Additional Benefits
The PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) plan offers comprehensive healthcare coverage with predictable out-of-pocket costs, including no copay to a $20 copay for primary care doctor visits. Inpatient hospital stays and outpatient surgical services are covered with no coinsurance, though daily copays apply for the first several days of a hospital stay. Emergency care is available with a $120 copay, which is waived if you are admitted, and urgently needed care requires a $50 copay. For extra wellness support, the plan features no copay and no coinsurance for annual physicals, fitness programs, routine vision exams, and diagnostic dental care up to a $1,000 annual limit. Routine hearing exams are available for a $25 copay, and the plan provides a $200 allowance every two years for contacts or eyeglasses. Additionally, patients pay no copay for the first 20 days in a skilled nursing facility and no copay for home health services.
Inpatient Hospital See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, there is a $425 daily copay for days 1-7 and no copay for subsequent days, while psychiatric stays require a $275 daily copay for days 1-6 and no copay for days 7-90. Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) are covered with no coinsurance, featuring a $0 to $425 copay for hospital services, a $425 copay per stay for observation services, and no copay for ambulatory surgical center services. Outpatient substance abuse services require a $35 copay per individual or group session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) covers emergency services with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours. Urgently needed services are covered with a $50 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are available with no coinsurance and copays ranging from $50 to $275.
Primary Care See details
Primary care services are covered by PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) with no coinsurance, featuring no copay to a $20 copay for primary care visits and no copay to a $35 copay for specialists. Other services like mental health, telehealth, and physical therapy are covered with no coinsurance and copays ranging from no copay to $35, while chiropractic care is partially covered (other chiropractic services are not covered) and podiatry is not covered.
Preventive Services See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) covers preventive services, such as annual physical exams and diabetes self-management, with no copay and no coinsurance. Additional preventive services are partially covered, offering a fitness benefit with no copay and no coinsurance, but excluding health education, personal emergency response systems, and nutritional therapy. Kidney disease education is also covered with no copay and a 20% coinsurance.
Hearing Services See details
Hearing services are covered by PacificSource Medicare MyCare Choice Rx 24 (HMO-POS), which features a $25 copay and no coinsurance for an annual routine hearing exam. Prescription hearing aids are partially covered with no coinsurance and a copay of $599 to $999 for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) offers partially covered vision services with no copay and no coinsurance for exams and eyewear, though eyewear upgrades are not covered. This benefit includes one routine eye exam per year and a $200 maximum allowance every two years for contacts or eyeglasses.
Dental Services See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) offers partially covered dental services, excluding orthodontics and maxillofacial prosthetics. Diagnostic and preventive dental care has no copay and no coinsurance up to a $1,000 annual limit, while comprehensive services require no copay and 50% coinsurance, and Medicare-covered dental has a $35 copay and no coinsurance.
Home Infusion bundled Services See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy apply. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) covers durable medical equipment and medical supplies with no copay and 20% coinsurance, and prosthetic devices with no copay and 0% to 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) partially covers diagnostic and radiological services, with prior authorization required, though outpatient X-ray services are not covered. Covered diagnostic procedures and tests require a 20% coinsurance and $15 copay, lab services feature no coinsurance, diagnostic radiological services have no copay, and therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization is required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) with no coinsurance, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) with no coinsurance and require prior authorization, with no prior three-day hospital stay required. There is no copay for days 1 through 20 and a $203 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by PacificSource Medicare MyCare Choice Rx 24 (HMO-POS), including acupuncture for a $25 copay and no coinsurance up to 12 treatments yearly, annual wellness visits with no copay and no coinsurance, and over-the-counter items with no copay and no coinsurance up to $25 every three months. Meal benefits and nicotine replacement therapy are not covered under this plan.
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