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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 2025, 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 2025.
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 $26.20. 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 $590.00 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 $9350.00 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 has an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible, you will pay coinsurance for your prescriptions. During the initial coverage phase, you will pay 25% coinsurance for preferred and standard generic drugs and non-preferred drugs. You will pay 27% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The PacificSource Dual Care (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including outpatient services, partial hospitalization, ambulance, primary care, vision, and medical equipment, have a 20% coinsurance. Emergency services have a 20% coinsurance, but the coinsurance is waived if admitted to the hospital within 3 days. Preventive services are covered with no copay for Medicare-covered services, while other preventive services have a 20% coinsurance. Home health services have no copay and no coinsurance, and diagnostic and radiological services have no copay. Additional benefits include coverage for hearing exams with a 20% coinsurance, and eyewear with a combined maximum of $200 per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. However, additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services, each with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by the PacificSource Dual Care (HMO D-SNP) plan with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PacificSource Dual Care (HMO D-SNP) plan. All ambulance services are covered with a 20% coinsurance for both ground and air ambulance services, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services and Urgently Needed Services are covered by the PacificSource Dual Care (HMO D-SNP) plan, with a 20% coinsurance; however, Worldwide Emergency Services are not covered. With Emergency Services, there is no copay, but the coinsurance is waived if admitted to the hospital within 3 days.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered with a 20% coinsurance. Routine Chiropractic Care has a 20% coinsurance with a limit of 10 visits per year. Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered. Medicare-covered preventive services and additional preventive services are covered with no copay, while the annual physical exam is not covered. Other preventive services, including glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, are covered with 20% coinsurance.
Hearing Services See details
Hearing services are partially covered under the PacificSource Dual Care (HMO D-SNP) plan. Hearing exams have a coinsurance of at most 20%, while routine hearing exams and fitting/evaluation for hearing aids are not covered. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a 20% coinsurance. Eyewear is covered with a combined maximum of $200 every year, and includes coverage for contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Upgrades are not covered.
Dental Services See details
Dental Services are partially covered by the PacificSource Dual Care (HMO D-SNP) plan. Medicare Dental Services are covered with a 20% coinsurance, while other services such as Orthodontic Services, Restorative Services, and others are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with 0-20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the PacificSource Dual Care (HMO D-SNP) plan. You will pay a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, is covered by the PacificSource Dual Care (HMO D-SNP). DME has a 20% coinsurance and requires authorization, while medical supplies, prosthetic devices, and diabetic supplies have a 20% coinsurance. Diabetic therapeutic shoes/inserts also have a 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for any services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the PacificSource Dual Care (HMO D-SNP) plan with no copay and no coinsurance. However, 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 Dual Care (HMO D-SNP) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays. The coinsurance for SNF services is the Medicare-defined cost share for tier 1.
Other Services See details
The PacificSource Dual Care (HMO D-SNP) plan covers acupuncture, limited to 10 treatments per year. It also covers over-the-counter (OTC) items, with a maximum benefit of $200 every three months. However, meal benefits, and other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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