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PacificSource Medicare MyCare Choice Rx 29 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Medicare MyCare Choice Rx 29 (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 29 (HMO-POS) in 2026, please refer to our full plan details page.
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) is a HMO-POS plan offered by PacificSource available for enrollment in 2025 to people living in Yellowstone County. 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 29 (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 29 (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 29 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.00. 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 $299.00 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 29 (HMO-POS) plan features an annual prescription drug deductible of $299. Under this plan, Tier 1 preferred generic drugs are available with no copay for one-month, two-month, and three-month supplies at standard pharmacies and standard mail order. Tier 2 generic medications require a $10 copay for a one-month supply, though standard mail order offers a flat $10 copay for up to a three-month supply. For brand-name and specialty medications, costs are determined by coinsurance percentages. Tier 3 preferred brand drugs require a 20% coinsurance at standard pharmacies and a reduced 15% coinsurance through standard mail order. Tier 4 non-preferred drugs carry a 25% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply.
Additional Benefits
The PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan offers robust medical coverage featuring no copays for primary care visits, annual wellness exams, and home health services. Inpatient hospital stays require a $360 daily copay for the first five days with no copay for additional days, while emergency room visits have a $120 copay and urgent care costs $50. Outpatient services and specialist visits are also highly accessible, requiring no coinsurance and copays ranging from no copay up to $360. Additionally, the plan provides strong dental, vision, and hearing benefits, including routine eye and preventive dental exams with no copays or coinsurance. Members benefit from a $1,500 annual preventive dental limit, a $200 eyewear allowance every two years, and a $25 quarterly allowance for over-the-counter items with no copay. Skilled nursing care is covered with no copay for the first 20 days, while routine hearing exams require a $40 copay.
Inpatient Hospital See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute stays carry a $360 daily copay for days 1 through 5 and no copay for additional days, while psychiatric stays require a $320 daily copay for days 1 through 5 and no copay for days 6 through 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $360, observation services require a $360 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) covers Medicare-approved ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. Routine transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Emergency services are covered under the PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan with a $120 copay, which is waived if admitted to the hospital within 72 hours, and no coinsurance. Urgently needed services have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays of $120, $50, and $300 respectively, and no coinsurance.
Primary Care See details
Primary care services are covered by PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) with no copay and no coinsurance for primary care visits, and a $0 to $40 copay with no coinsurance for specialists. While physical, speech, and occupational therapies require a $25 copay and no coinsurance, podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by PacificSource Medicare MyCare Choice Rx 29 (HMO-POS), featuring an annual physical, fitness benefits, and screenings with no copay and no coinsurance, plus kidney education with no copay and a 20% coinsurance. Non-covered services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional tobacco cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) covers annual routine hearing exams with a $40 copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $999 for up to two devices per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam annually and exams for glaucoma and diabetic retinopathy. Eyewear, including contacts and eyeglasses, is covered with no copay or coinsurance up to a $200 combined maximum every two years, though upgrades are not covered.
Dental Services See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) dental services are partially covered, excluding maxillofacial prosthetics and orthodontics. Preventive and diagnostic dental care is covered with no copay and no coinsurance up to a $1,500 annual limit, while Medicare-covered dental requires a $40 copay and no coinsurance. Covered comprehensive services, such as restorative and endodontic care, are available with no copay and 50% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic equipment with no copays, subject to prior authorization. A 20% coinsurance applies to durable medical equipment, medical supplies, and diabetic supplies and footwear, while prosthetic devices range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) partially covers diagnostic and radiological services with prior authorization required, though outpatient X-ray services are not covered. Covered diagnostic procedures require a $40 copay and 20% coinsurance, lab services require a copay with no coinsurance, diagnostic radiological services have no copay, and therapeutic radiological services require a copay and 20% coinsurance.
Home Health Services See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) with no coinsurance; however, while some services are covered, standard cardiac rehabilitation (with a $35 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for symptomatic peripheral artery disease services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) 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, followed by a $203 daily copay for days 21 through 100, with no coverage available for additional days.
Other Services See details
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) partially covers other services, offering an Annual Wellness Visit and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $25 every three months, while acupuncture, meal benefits, and nicotine replacement therapy are not covered.
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