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PacificSource Dual Care Alliance (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Dual Care Alliance (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 Alliance (HMO D-SNP) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
PacificSource Dual Care Alliance (HMO D-SNP) is a HMO D-SNP plan offered by Pacificsource Community Health Plans available for the 2026 plan year 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 Alliance (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 Alliance (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 Alliance (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 Alliance (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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 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:
Sign up for PacificSource Dual Care Alliance (HMO D-SNP)
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Drug Coverage
The PacificSource Dual Care Alliance (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members benefit from no copay for one-, two-, or three-month supplies at standard pharmacies and standard mail order. This structure helps lower upfront costs for the most commonly prescribed generic medications. For other medication tiers, costs are shared through coinsurance during the initial coverage phase at standard pharmacies and standard mail order. Tier 2 generic, Tier 3 preferred brand, and Tier 5 specialty drugs (one-month supply) require a 25% coinsurance. Tier 4 non-preferred drugs have a 26% coinsurance for one-, two-, and three-month supplies.
Additional Benefits
The PacificSource Dual Care Alliance (HMO D-SNP) offers comprehensive medical coverage featuring no copay and no coinsurance for inpatient hospital stays, home health services, and skilled nursing facility care. For most outpatient services, primary care, specialist visits, and medical equipment, members will pay no copay and a 20% coinsurance. Emergency and urgent care services are also covered with no copay and a 20% coinsurance. This plan also includes extra benefits, such as a $190 annual allowance for eyewear and diagnostic hearing exams with no copay or deductible. Additionally, members can take advantage of an over-the-counter allowance of up to $125 every three months with no copay and no coinsurance. While Medicare-approved dental services are covered with a 20% coinsurance, routine preventive dental care and hearing aids are not covered.
Inpatient Hospital See details
PacificSource Dual Care Alliance (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
PacificSource Dual Care Alliance (HMO D-SNP) covers outpatient services with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for ambulatory surgical center and outpatient hospital services.
Partial Hospitalization See details
PacificSource Dual Care Alliance (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
PacificSource Dual Care Alliance (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
PacificSource Dual Care Alliance (HMO D-SNP) covers emergency services with no copay and a 20% coinsurance up to $115 (waived if admitted within 3 days), and urgently needed services with no copay and a 20% coinsurance up to $40. While worldwide emergency services are technically covered, worldwide emergency, urgent, and emergency transportation services are not covered in practice.
Primary Care See details
PacificSource Dual Care Alliance (HMO D-SNP) covers primary care, specialist visits, mental health, physical and occupational therapies, and telehealth services with no copay and a 20% coinsurance. Chiropractic and podiatry services are not covered under these benefits.
Preventive Services See details
Preventive Services are partially covered by PacificSource Dual Care Alliance (HMO D-SNP), featuring zero-dollar Medicare preventive services and fitness benefits with no copay and no coinsurance. Kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome-visit EKGs are covered with no copay and 20% coinsurance. Annual physical exams, health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling are not covered.
Hearing Services See details
PacificSource Dual Care Alliance (HMO D-SNP) covers diagnostic hearing exams with no copay, no coinsurance, and no deductible, though routine hearing exams and fitting evaluations are not covered. For prescription hearing aids, some services are covered, but all types—including inner ear, outer ear, and over the ear models—along with OTC hearing aids, are not covered in practice.
Vision Services See details
PacificSource Dual Care Alliance (HMO D-SNP) covers routine and diagnostic eye exams with no copay, 20% coinsurance for routine exams, and no deductible. Eyewear is partially covered with no copay, no coinsurance, and no deductible up to a $190 annual limit for contacts and eyeglasses, though upgrades are not covered.
Dental Services See details
PacificSource Dual Care Alliance (HMO D-SNP) covers Medicare-approved dental services with no copay and a 20% coinsurance, requiring prior authorization. Preventive and comprehensive dental services, including cleanings, exams, X-rays, fluoride, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PacificSource Dual Care Alliance (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy and radiation, require no coinsurance to 20% coinsurance, while insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the PacificSource Dual Care Alliance (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
PacificSource Dual Care Alliance (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with no copay and 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 Alliance (HMO D-SNP) partially covers diagnostic and radiological services, which require prior authorization and feature no copay alongside a 20% coinsurance. While diagnostic procedures, radiological services, and outpatient X-rays are covered under this benefit, laboratory services are not covered.
Home Health Services See details
Home Health Services are covered by PacificSource Dual Care Alliance (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PacificSource Dual Care Alliance (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay, but the benefit is not covered in practice as all major sub-services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
PacificSource Dual Care Alliance (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and a prior three-day inpatient hospital stay are required. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by PacificSource Dual Care Alliance (HMO D-SNP), featuring an over-the-counter (OTC) benefit of up to $125 every three months with no copay and no coinsurance. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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