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PacificSource Medicare Explorer 6 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Medicare Explorer 6 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PacificSource Medicare Explorer 6 (PPO) in 2025, please refer to our full plan details page.
PacificSource Medicare Explorer 6 (PPO) is a PPO plan offered by PacificSource available for enrollment in 2025 to people living in Select Oregon and Idaho Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that PacificSource Medicare Explorer 6 (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PacificSource Medicare Explorer 6 (PPO).
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 Explorer 6 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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 Explorer 6 (PPO)
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Drug Coverage
Prescription drugs are not covered by PacificSource Medicare Explorer 6 (PPO).
Additional Benefits
The PacificSource Medicare Explorer 6 (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. Emergency, primary care, preventive, hearing, vision, and dental services are also covered, often with copays, though some services like eyewear and home health have no copay. The plan also covers ambulance, home infusion, dialysis, and medical equipment, with differing copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $250 per day for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $230 per day for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, along with Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $250, and observation services, with a $250 copay. Ambulatory Surgical Center (ASC) services are covered with no copay, but individual and group sessions for outpatient substance abuse, as well as outpatient blood services, are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the PacificSource Medicare Explorer 6 (PPO) plan with a $35 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PacificSource Medicare Explorer 6 (PPO) plan. Ground and Air Ambulance Services have a $250 copay, with no coinsurance, while 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 have a $120 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The PacificSource Medicare Explorer 6 (PPO) plan covers primary care physician services, chiropractic services (24 visits per year), occupational therapy services, physician specialist services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, annual physical exams, and other preventive services. Kidney Disease Education Services have a 20% coinsurance, and Fitness Benefit is covered. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $35 copay. Prescription hearing aids are covered, with a copay between $599 and $999 for all types, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
The PacificSource Medicare Explorer 6 (PPO) plan covers vision services including routine eye exams once per year and other eye exam services. Eyewear benefits are covered with a $0 copay for contact lenses, and there is a combined maximum of $250 per year for eyewear.
Dental Services See details
Dental Services are covered, with a $35 copay for Medicare Dental Services and a $1,000 maximum benefit per year. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery have a 50% coinsurance, while 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 with a $35 copay, and a coinsurance between 0% and 20% for Medicare Part B Insulin, Chemotherapy/Radiation, and Other Part B drugs. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the PacificSource Medicare Explorer 6 (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with 20% coinsurance and Prosthetic Devices with up to 20% coinsurance. Medical Supplies have a 20% coinsurance, and Diabetic Equipment is covered. However, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay of $15 and a coinsurance of at most 20%, while Lab Services have a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of up to $310, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the PacificSource Medicare Explorer 6 (PPO) 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 Medicare Explorer 6 (PPO) plan. Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PacificSource Medicare Explorer 6 (PPO) plan, with 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
Other Services include acupuncture and over-the-counter (OTC) items. Acupuncture is covered, with a limit of 24 treatments per year. OTC items are covered up to $50 every three months, and the plan does not offer Nicotine Replacement Therapy (NRT) as a Part C OTC benefit. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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