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PacificSource Medicare Essentials Rx 27 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Medicare Essentials Rx 27 (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 27 (HMO) in 2026, please refer to our full plan details page.
PacificSource Medicare Essentials Rx 27 (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 27 (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 27 (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 27 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $61.00. 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 $399.00 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 $6700.00 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 27 (HMO) plan features an annual prescription drug deductible of $399. Under this plan, Tier 1 preferred generic drugs are available with no copay for one-, two-, or three-month supplies through standard pharmacies and mail order. For Tier 2 generic medications, you will pay an $8 copay per month at standard pharmacies, while standard mail order offers a flat $8 copay for one-, two-, or three-month supplies. For Tier 3 preferred brand drugs, the plan requires a 20% coinsurance at standard pharmacies and a lower 15% coinsurance through standard mail order. Tier 4 non-preferred drugs carry a 25% coinsurance for both pharmacy and mail order options, while Tier 5 specialty drugs require a 28% coinsurance for a one-month supply. These structured costs help you easily plan your healthcare budget when choosing the PacificSource Medicare Essentials Rx 27 (HMO) plan.
Additional Benefits
The PacificSource Medicare Essentials Rx 27 (HMO) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no coinsurance for inpatient hospital stays, outpatient services, and doctor visits. Primary care visits range from no copay to a $20 copay, while specialist visits cost up to a $40 copay. For inpatient hospital stays, members pay a $395 daily copay for the first several days and no copay thereafter. This plan also includes valuable everyday care, such as routine vision exams and a $200 eyewear allowance every two years with no copay or coinsurance. Preventive dental services also feature no copay, while prescription hearing aids are covered with copays ranging from $599 to $999. Additionally, members enjoy home health services with no copay and a $20 quarterly over-the-counter allowance.
Inpatient Hospital See details
PacificSource Medicare Essentials Rx 27 (HMO) covers inpatient hospital services with no coinsurance, requiring prior authorization and a $395 daily copay for days 1 to 7 of acute stays and days 1 to 4 of psychiatric stays, with no copay thereafter. This benefit is partially covered because upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
PacificSource Medicare Essentials Rx 27 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require prior authorization and have a copay ranging from $0 to $395, while observation services carry a $395 copay per stay. Outpatient substance abuse individual and group sessions are covered with a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by PacificSource Medicare Essentials Rx 27 (HMO) with a $55.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
PacificSource Medicare Essentials Rx 27 (HMO) covers Medicare-covered ground and air ambulance services with a $325 copay and no coinsurance, though prior authorization is required. Routine transportation services, including trips to plan-approved or any health-related locations, are not covered under this plan.
Emergency Services See details
PacificSource Medicare Essentials Rx 27 (HMO) covers emergency services with a $120 copay, which is waived if admitted to the hospital within 72 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency services are also covered with no coinsurance, requiring a $120 copay for emergency care, a $50 copay for urgent care, and a $325 copay for emergency transportation.
Primary Care See details
Primary care benefits under PacificSource Medicare Essentials Rx 27 (HMO) feature no coinsurance, with primary care physician visits ranging from no copay to a $20 copay, and specialist visits ranging from no copay to $40. Most other services, including therapy, telehealth, and mental health, are covered with no coinsurance and copays up to $40, though podiatry and select chiropractic services are not covered.
Preventive Services See details
PacificSource Medicare Essentials Rx 27 (HMO) preventive services are partially covered, featuring annual physical exams and other routine screenings with no copay and no coinsurance. While kidney disease education has no copay and a 20% coinsurance, alternative therapies are covered with a $25 copay and no coinsurance for up to 12 visits. Several supplemental services, including health education, therapeutic massage, and in-home safety assessments, are not covered.
Hearing Services See details
Hearing services covered by PacificSource Medicare Essentials Rx 27 (HMO) include annual routine exams for a $25 copay and fitting evaluations with no copay, both featuring no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $999 for up to two devices per year, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
PacificSource Medicare Essentials Rx 27 (HMO) covers vision services with no copay, no coinsurance, and no deductible. This benefit includes one routine eye exam every two years, covered diagnostic eye exams, and a $200 allowance every two years for contact lenses and eyeglasses, though eyewear upgrades are not covered.
Dental Services See details
PacificSource Medicare Essentials Rx 27 (HMO) dental services are partially covered, excluding maxillofacial prosthetics and orthodontics. Medicare-covered dental services require a $50 copay and no coinsurance, while preventive services have no copay and no coinsurance up to a $500 annual limit, and other covered comprehensive services require no copay and 50% coinsurance.
Home Infusion bundled Services See details
PacificSource Medicare Essentials Rx 27 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require no copay and 0% (no coinsurance) to 20% coinsurance, while Part B insulin has a $35 copay and 0% (no coinsurance) to 20% coinsurance.
Dialysis Services See details
PacificSource Medicare Essentials Rx 27 (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
PacificSource Medicare Essentials Rx 27 (HMO) covers medical equipment, including durable medical equipment (DME), medical supplies, and diabetic services, with no copays and a 20% coinsurance. Covered prosthetic devices feature a coinsurance ranging from no coinsurance to 20%, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
PacificSource Medicare Essentials Rx 27 (HMO) covers diagnostic and radiological services under prior authorization. Diagnostic tests require a $20 copay and 20% coinsurance, therapeutic radiology requires a copay and 20% coinsurance, and lab services and X-rays have no copay with coinsurance, while diagnostic radiology is covered with no copay and no coinsurance.
Home Health Services See details
Home health services are covered by PacificSource Medicare Essentials Rx 27 (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PacificSource Medicare Essentials Rx 27 (HMO) covers cardiac rehabilitation services with no coinsurance, though copays apply depending on the specific service. Patients will pay a $35 copay for cardiac rehabilitation, a $50 copay for intensive cardiac rehabilitation, a $15 copay for pulmonary rehabilitation, and a $25 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
PacificSource Medicare Essentials Rx 27 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no 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 Medicare-covered limit are not covered.
Other Services See details
PacificSource Medicare Essentials Rx 27 (HMO) partially covers other services, offering acupuncture at a $25 copay and no coinsurance for up to 12 treatments annually, an annual wellness visit with no copay and no coinsurance, and a $20 quarterly over-the-counter allowance with no copay or coinsurance. Meal benefits and nicotine replacement therapy are not covered under these benefits.
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