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PacificSource Medicare MyCare Choice Rx 34 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Medicare MyCare Choice Rx 34 (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 34 (HMO-POS) in 2026, please refer to our full plan details page.
PacificSource Medicare MyCare Choice Rx 34 (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 34 (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 34 (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 34 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.00. 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 MyCare Choice Rx 34 (HMO-POS) plan features an annual drug deductible of $199. Tier 1 preferred generic drugs are covered with no copay for one, two, or three-month fills at standard pharmacies and standard mail order. For Tier 2 generic drugs, standard pharmacies charge a $10 copay for a one-month supply, while standard mail order offers a flat $10 copay for up to a three-month supply. Tier 3 preferred brand drugs require a 24% coinsurance at standard pharmacies and a 15% coinsurance through standard mail order. Tier 4 non-preferred drugs carry a 28% coinsurance across both standard pharmacies and mail order services. Lastly, Tier 5 specialty drugs are subject to a 30% coinsurance for a one-month supply at standard pharmacies and mail order.
Additional Benefits
The PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no coinsurance for inpatient hospital stays and daily copays up to $425 for the first seven days. Primary care visits range from no copay to a $10 copay, while specialist visits require a copay of up to $40. Emergency room visits carry a $120 copay, which is waived upon hospital admission, and urgent care visits require a $50 copay. For supplemental care, members enjoy routine vision exams, eyewear, and preventive dental services with no copay and no coinsurance. Preventive medical screenings and home health services are also fully covered with no copay or coinsurance. Additionally, the plan provides a $1,500 annual dental limit and a $25 quarterly over-the-counter allowance with no copays.
Inpatient Hospital See details
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) covers inpatient hospital care with no coinsurance, requiring a $425 copay for days 1 to 7 of acute stays and a $325 copay for days 1 to 7 of psychiatric stays, with no copay for subsequent days. Additional acute days are fully covered with no copay, while non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) with no coinsurance, featuring outpatient hospital copays from $0 to $315 and observation services at a $315 copay per stay. Ambulatory surgical center and blood services require no copay and no coinsurance, while outpatient substance abuse individual and group sessions carry a $40 copay.
Partial Hospitalization See details
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by PacificSource Medicare MyCare Choice Rx 34 (HMO-POS), with ground and air ambulance services requiring a $300 copay, no coinsurance, and prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $120, $50, and $300, respectively.
Primary Care See details
Primary care benefits under PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) are partially covered with no coinsurance, though podiatry and other chiropractic services are not covered. Covered services range from no copay to a $10 copay for primary care visits, and up to a $40 copay for specialized care, therapy, and mental health services.
Preventive Services See details
Preventive services are partially covered by PacificSource Medicare MyCare Choice Rx 34 (HMO-POS), with annual physical exams and other routine screenings requiring no copay and no coinsurance. While kidney disease education has no copay and a 20% coinsurance, and alternative therapies require a $25 copay, several supplemental services such as health education, weight management, and nutritional/dietary benefits are not covered.
Hearing Services See details
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) partially covers hearing services with no deductible, offering one annual routine exam for a $30 copay and no coinsurance. Up to two prescription hearing aids are covered each year with no coinsurance and a copay ranging from $599 to $999, though OTC, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by PacificSource Medicare MyCare Choice Rx 34 (HMO-POS), offering eye exams and eyewear with no copay and no coinsurance. This benefit includes one routine eye exam per year and a $200 combined limit every two years for contacts and eyeglasses, while eyewear upgrades are not covered.
Dental Services See details
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) offers partially covered dental services up to a $1,500 annual limit, featuring no copay and no coinsurance for preventive care, and no copay with a 50% coinsurance for comprehensive services. Medicare-covered dental services require a $40 copay and no coinsurance, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) covers Home Infusion bundled Services with no copay and no coinsurance, subject to prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while covered insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) covers medical equipment with no copay and generally 20% coinsurance, though prosthetic devices range from no coinsurance to 20% coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and diabetic supplies, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under PacificSource Medicare MyCare Choice Rx 34 (HMO-POS), requiring prior authorization and excluding outpatient X-ray services. Covered diagnostic procedures and tests require a 20% coinsurance and $15 copay, lab services carry a copay with 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 34 (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) with no coinsurance. Members will pay a $35 copay for both standard and 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 MyCare Choice Rx 34 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $203 daily copay for days 21 through 100, with additional days beyond the Medicare-covered limit not covered.
Other Services See details
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) partially covers other services, offering acupuncture with a $25 copay and no coinsurance for up to 12 treatments yearly, and annual wellness visits with no copay and no coinsurance. Over-the-counter items are covered with no copay and no coinsurance up to $25 every three months, while nicotine replacement therapy and meal benefits are not covered.
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