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PacificSource Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Dual Care (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PacificSource Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
PacificSource Dual Care (HMO D-SNP) is a HMO D-SNP 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 Dual Care (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
PacificSource Dual Care (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PacificSource Dual Care (HMO D-SNP).
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 Dual Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.50. 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 $615.00 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 Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Dual Care (HMO D-SNP) plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order for up to a three-month supply. For Tier 2 generic and Tier 3 preferred brand drugs, you will pay a 25% coinsurance rate for standard pharmacy fills and mail orders. Tier 4 non-preferred drugs require a 26% coinsurance payment for one-, two-, or three-month supplies. Tier 5 specialty drugs carry a 25% coinsurance rate, which is limited to a one-month supply for standard retail and mail-order options. This structured cost-sharing allows you to easily estimate your out-of-pocket expenses based on your specific prescription needs.
Additional Benefits
The PacificSource Dual Care (HMO D-SNP) plan offers comprehensive coverage where many medical services, including outpatient care, emergency visits, primary and specialist care, and medical equipment, require no copay and a 20% coinsurance. High-tier benefits like inpatient hospital stays, home health services, and select diagnostic hearing exams are fully covered with no copay and no coinsurance. However, many of these covered services do require prior authorization before you can receive care. For supplemental care, the plan provides vision exams with a 20% coinsurance and eyewear with no copay or coinsurance up to a $190 annual limit, alongside a quarterly $130 allowance for over-the-counter items. While Medicare-covered dental services are available with a 20% coinsurance, routine non-Medicare dental care, hearing aids, and transportation services are not covered. Prescription insulin is also subject to a $35 copay under this plan.
Inpatient Hospital See details
PacificSource Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance per admission, though prior authorization is required. This benefit is partially covered, as additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
PacificSource Dual Care (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for ambulatory surgical center and certain outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization services are covered by PacificSource Dual Care (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization.
Ambulance and Transportation Services See details
PacificSource Dual Care (HMO D-SNP) covers Medicare-approved ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
PacificSource Dual Care (HMO D-SNP) covers emergency services with a 20% coinsurance (up to $115 per visit) and no copay, which is waived if you are admitted to the hospital within three days. Urgently needed services are also covered with a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency services are not covered.
Primary Care See details
Primary Care and specialty services under PacificSource Dual Care (HMO D-SNP) are generally covered with no copay and a 20% coinsurance, including specialist visits, physical therapy, mental health, telehealth, and occupational therapy. However, chiropractic and podiatry services are not covered, and prior authorization is required for several benefits.
Preventive Services See details
PacificSource Dual Care (HMO D-SNP) partially covers preventive services, offering Medicare-covered zero-dollar services and fitness benefits with no copay and no coinsurance. Kidney disease education and other select screenings have no copay and a 20% coinsurance, though several services, including annual physical exams, health education, and in-home safety assessments, are not covered.
Hearing Services See details
PacificSource Dual Care (HMO D-SNP) hearing exams are partially covered, offering diagnostic exams with no copay, no coinsurance, and no deductible, while routine exams and fitting or evaluation services are not covered. For prescription hearing aids, some services are covered but all specific types of prescription hearing aids (inner ear, outer ear, and over the ear) and over-the-counter hearing aids are not covered.
Vision Services See details
PacificSource Dual Care (HMO D-SNP) covers vision services, featuring eye exams with no copay and a 20% coinsurance, and eyewear with no copay, no coinsurance, and a $190 annual limit. Eyewear upgrades are not covered.
Dental Services See details
PacificSource Dual Care (HMO D-SNP) dental services are partially covered, providing Medicare-covered dental care with no copay and a 20% coinsurance, subject to prior authorization. Non-Medicare dental services, including preventive cleanings, oral exams, x-rays, fluoride, and restorative treatments, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PacificSource Dual Care (HMO D-SNP) with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and insulin, are subject to a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the PacificSource Dual Care (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
PacificSource Dual Care (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
PacificSource Dual Care (HMO D-SNP) partially covers diagnostic and radiological services with no copay and a 20% coinsurance, subject to prior authorization. Covered benefits include diagnostic procedures, therapeutic radiology, and outpatient X-rays, while lab services are not covered.
Home Health Services See details
Home Health Services are covered under the PacificSource Dual Care (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
PacificSource Dual Care (HMO D-SNP) offers cardiac rehabilitation services with no copay, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under the plan and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
PacificSource Dual Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and Medicare-defined coinsurance, though prior authorization and a three-day prior inpatient hospital stay are required. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
PacificSource Dual Care (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $130 every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this plan.
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