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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 2025, 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 2025.
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 $10.00. 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 has a $299.00 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you'll pay a $12.00 copay at a preferred pharmacy, and $17.00 at a standard pharmacy. For preferred brand drugs, you'll pay 31% coinsurance at a preferred pharmacy, and 33% at a standard pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan provides coverage for a variety of services. This plan covers inpatient hospital stays with a copay, outpatient services with varying copays, and emergency services with a copay. You can also expect coverage for primary care, preventive services, and hearing, vision, and dental services. Additional benefits include coverage for home health services with no copay, skilled nursing facility (SNF) services with no copay for the first 20 days, and home infusion services with a copay and coinsurance. The plan also covers ambulance, dialysis, and diagnostic services with a copay or coinsurance, and offers a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $360 copay for days 1-5, and no copay for days 6-90; and for Inpatient Hospital Psychiatric, you'll pay a $320 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services and observation services, are covered. Outpatient hospital services have a copay between $0 and $360, while observation services have a $360 copay per stay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a copay of $40 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay.
Ambulance and Transportation Services See details
Ambulance services are covered, with a $300 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan. Emergency Services have a $120 copay, while Urgently Needed Services have a $55 copay, and Worldwide Emergency Services have varying copays. Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan covers primary care, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, specialist services with a copay between $0 and $40, mental health specialty services with a $40 copay, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $40 copay. However, routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
The PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and other preventive services. Kidney Disease Education Services have a 20% coinsurance, and other services like health education, in-home safety assessments, and several others are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay for routine hearing exams. Prescription hearing aids are partially covered, with a copay between $599 and $999 for all types of hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam covered every year, and other eye exam services. Eyewear is covered, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $200 every two years. Upgrades are not covered.
Dental Services See details
Dental services are covered and include Medicare dental services with a $40 copay. Other services are covered with a $1,500 maximum per year, and include oral exams, dental x-rays, and other diagnostic and preventive services with no copay and no coinsurance, as well as restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, implant services, fixed prosthodontics, and oral and maxillofacial surgery with a 50% coinsurance. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. There is a $35 copay for Medicare Part B Insulin Drugs, and a coinsurance between 0% and 20% for all services.
Dialysis Services See details
Dialysis Services are covered by the PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
The PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires authorization, but DME for use outside the home is not covered. Prosthetic devices have a 0-20% coinsurance, and medical supplies have a 20% coinsurance. Diabetic equipment is covered, with a 20% coinsurance for diabetic supplies and diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Therapeutic Radiological Services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a copay of up to $450, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $203.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with a maximum benefit of $25 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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