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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 2026, 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 2026.
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 $28.00. 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:
Sign up for PacificSource Medicare Essentials Choice Rx 36 (HMO-POS)
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Drug Coverage
The PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan features an annual drug deductible of $499. Under this plan, Tier 1 preferred generic drugs are available with no copay at standard pharmacies and through standard mail order. Tier 2 generic drugs carry a low $6 copay for a one-month supply at standard pharmacies, while standard mail order offers a flat $6 copay for up to a three-month supply. For Tier 3 preferred brand drugs, you will pay a 20% coinsurance at standard pharmacies, which drops to a 15% coinsurance when using standard mail order. Tier 4 non-preferred drugs require a 25% coinsurance for both standard pharmacy and mail order options. Tier 5 specialty drugs are covered with a 27% coinsurance for a one-month supply.
Additional Benefits
The PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan offers robust coverage with no copay for primary care provider visits, annual physicals, and routine preventive screenings. For inpatient hospital stays, members pay no coinsurance and a daily copay of $425 for the first seven days, followed by no copay for subsequent unlimited days. Emergency room visits carry a $120 copay, which is waived if you are admitted to the hospital within 72 hours. This plan also includes essential dental, vision, and hearing benefits, such as preventive dental care with no copay up to a $1,000 annual limit and routine eye exams with no copay. Routine hearing exams require a $25 copay, while prescription hearing aids are covered with copays ranging from $599 to $999. Additionally, members receive a $200 eyewear allowance every two years and can access over-the-counter items with no copay up to a $15 limit every three months.
Inpatient Hospital See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute care requires a $425 daily copay for days 1 to 7 and no copay for subsequent unlimited days, while psychiatric care requires a $405 daily copay for days 1 to 4 and no copay for days 5 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) outpatient services are covered with no coinsurance, featuring a $0 to $425 copay for outpatient hospital services, a $425 copay per stay for observation services, and a $50 copay for outpatient substance abuse sessions. Ambulatory surgical center services and outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) covers ground and air ambulance services with a $350 copay and no coinsurance, which require prior authorization. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) 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 featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $120, $50, and $350, respectively.
Primary Care See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) primary care benefits are partially covered, as podiatry services and other chiropractic services are not covered. All covered services feature no coinsurance, with copays ranging from no copay for primary care visits up to $50 for opioid treatment program services.
Preventive Services See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) covers preventive services, including annual physicals and various screenings with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance with no copay. Additional preventive benefits are partially covered, offering alternative therapies for a $25 copay (up to 12 visits) and fitness benefits, while sub-services like health education, nutritional/dietary benefits, and in-home safety assessments are not covered.
Hearing Services See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) partially covers hearing services, offering routine hearing exams for a $25 copay and no coinsurance, and up to two prescription hearing aids per year with a $599 to $999 copay and no coinsurance. OTC hearing aids, as well as prescription hearing aids for the inner ear, outer ear, and over the ear, are not covered.
Vision Services See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) vision services are partially covered with no copay, no coinsurance, and no deductible. The plan covers one routine eye exam annually and provides a $200 combined maximum allowance every two years for contact lenses and eyeglasses, though eyewear upgrades are not covered.
Dental Services See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) dental services are partially covered, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care up to a $1,000 annual maximum. Comprehensive services like endodontics and implants are covered with no copay and 50% coinsurance, while orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) covers medical equipment, including durable medical equipment, diabetic supplies, and prosthetics, with no copays and a 20% coinsurance, though prosthetic devices range from no coinsurance to 20% coinsurance. Prior authorization is required for these covered services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) plan, with prior authorization required for all services. Diagnostic procedures and tests carry a $40 copay and 20% coinsurance, while lab services feature no coinsurance. Diagnostic radiological and outpatient x-ray services are offered with no copay, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under PacificSource Medicare Essentials Choice Rx 36 (HMO-POS), though only some services are covered. Standard cardiac rehabilitation (with a $35 copay), intensive cardiac rehabilitation (with a $50 copay), pulmonary rehabilitation (with a $15 copay), and supervised exercise therapy for symptomatic peripheral artery disease (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay no copay for days 1 through 20 and a $203 daily copay for days 21 through 100, though additional days beyond the first 100 are not covered.
Other Services See details
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) covers acupuncture with a $25 copay and no coinsurance for up to 12 treatments per year, alongside an annual wellness visit with no copay and no coinsurance. Over-the-counter (OTC) items are also covered with no copay and no coinsurance up to a $15 limit every three months, though meal benefits are not covered.
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