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PacificSource Medicare Essentials Choice Rx 36 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Medicare Essentials Choice Rx 36 (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 Essentials Choice Rx 36 (HMO-POS) in 2025, please refer to our full plan details page.
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) is a HMO-POS 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 2025.
It's important to know that PacificSource Medicare Essentials Choice Rx 36 (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 Essentials Choice Rx 36 (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 Essentials Choice Rx 36 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.00. 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 Essentials Choice Rx 36 (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $499. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you will pay $12 or $17 for a 30-day supply of a preferred generic drug, depending on the pharmacy. For preferred brand drugs, you will pay 31% or 33% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. The plan also covers essential services like primary care, preventive care, hearing, vision, and dental, with copays and coinsurance depending on the specific service. Additionally, the plan provides benefits for ambulance, emergency services, and home health services, with some services having no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you have a $425 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you have a $405 copay for days 1-4, and no copay for days 5-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
The PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $425, observation services with a $425 copay, and ambulatory surgical center services with no copay. The plan also covers outpatient substance abuse services, with individual and group sessions having a copay between $50 and $50. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan. Ground and air ambulance services each have a $350 copay, and there is 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. Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $55 copay, and Worldwide Emergency Transportation has a $350 copay; all have no coinsurance.
Primary Care See details
The "PacificSource Medicare Essentials Choice Rx 36 (HMO-POS)" plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $0-$35 copay, mental health specialty services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a $0-$40 copay, and opioid treatment program services with a $50 copay. Podiatry services are not covered.
Preventive Services See details
The PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, and additional services like alternative therapies with a $25 copay per visit up to 12 visits, and a fitness benefit. The plan also covers kidney disease education services with 20% coinsurance. Other services such as Health Education, In-Home Safety Assessment, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $50 copay, and routine hearing exams (1 per year) and fitting/evaluation for hearing aids are also covered. Prescription hearing aids are covered, with a copay between $599 and $999, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Routine eye exams are covered once per year, and other eye exam services are unlimited. Eyewear has a combined maximum plan benefit of $200 every two years and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
Dental services are covered, with a $40 copay for Medicare dental services, and a maximum plan benefit of $1500 per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), implant services, prosthodontics (fixed), and oral and maxillofacial surgery have 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, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance, while all other included drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance between 0% and 20%, and Medical Supplies have a 20% coinsurance. For Diabetic Supplies and Therapeutic Shoes/Inserts, the coinsurance is between 20% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, and radiological services. For Diagnostic Procedures/Tests, there is a copay of $40.00 and a coinsurance of at most 20%, while lab services have a coinsurance of at most 20% and no copay. Diagnostic Radiological Services have a copay of up to $450.00 and no coinsurance, and Therapeutic Radiological Services have a coinsurance of at most 20% and no copay. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the PacificSource Medicare Essentials Choice Rx 36 (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 covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay for Cardiac Rehabilitation Services is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan covers acupuncture with a $25 copay for up to 12 treatments per year, and also covers over-the-counter items up to $15 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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