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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 2026, 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 Idaho and Oregon Counties. This plan received an overall rating of 3 out of 5 stars in 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $105.00. You must continue to pay paying your reduced 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:
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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 medical coverage with predictable out-of-pocket costs. Inpatient hospital stays require a $250 daily copay for the first five days and no copay thereafter, while emergency care carries a $120 copay. Routine healthcare is highly affordable, featuring no copay for annual wellness visits and primary care copays ranging from no copay to $20. Supplemental benefits include routine vision exams with no copay, a $200 annual eyewear allowance, and up to $1,000 yearly for dental care. Routine hearing exams require a $20 copay, while durable medical equipment and dialysis services generally feature a 20% coinsurance. Additionally, home health services have no copay, and skilled nursing facility stays require no copay for the first 20 days.
Inpatient Hospital See details
PacificSource Medicare Explorer 6 (PPO) covers inpatient acute hospital stays with a $250 daily copay for days 1 through 5, no copay for days 6 and beyond, and no coinsurance. Inpatient psychiatric care is partially covered with a $230 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PacificSource Medicare Explorer 6 (PPO) covers outpatient hospital services with a $0 to $250 copay, observation services with a $250 copay, and ambulatory surgical and blood services with no copay, all with no coinsurance. For outpatient substance abuse, some services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
PacificSource Medicare Explorer 6 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under PacificSource Medicare Explorer 6 (PPO) include Medicare-covered ground and air ambulance services for a $250 copay per service and no coinsurance, requiring prior authorization. Non-emergency transportation services to health-related locations are not covered under this plan.
Emergency Services See details
PacificSource Medicare Explorer 6 (PPO) covers emergency services with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance, requiring copays of $120, $50, and $250 respectively.
Primary Care See details
PacificSource Medicare Explorer 6 (PPO) covers primary care and specialist services with no coinsurance and copays ranging from no copay to $20.00, while physical, occupational, and speech therapies require a $20.00 copay and no coinsurance. Chiropractic care is partially covered with a $15.00 to $20.00 copay and no coinsurance, but other chiropractic services and podiatry are not covered. For mental health and psychiatric benefits, some services are covered but individual and group sessions are not covered.
Preventive Services See details
Preventive Services for the PacificSource Medicare Explorer 6 (PPO) are partially covered, offering annual physical exams, fitness benefits, and routine screenings with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while several supplemental services—including health education, nutritional therapy, and in-home safety assessments—are not covered.
Hearing Services See details
PacificSource Medicare Explorer 6 (PPO) provides partially covered hearing services, featuring one routine hearing exam annually for a $20 copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and copayments ranging from $599 to $999, but OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
PacificSource Medicare Explorer 6 (PPO) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam annually and unlimited exams for glaucoma and diabetic retinopathy. Eyewear is partially covered with no copay or coinsurance up to a $200 yearly limit for contacts and glasses, though upgrades are not covered.
Dental Services See details
PacificSource Medicare Explorer 6 (PPO) partially covers dental services, excluding maxillofacial prosthetics and orthodontics, with a $1,000 annual limit on non-Medicare dental care. Preventive services have no copay and no coinsurance, Medicare-covered services require a $35 copay and no coinsurance, and other covered comprehensive services have no copay and a 50% coinsurance.
Home Infusion bundled Services See details
PacificSource Medicare Explorer 6 (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by PacificSource Medicare Explorer 6 (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
PacificSource Medicare Explorer 6 (PPO) covers durable medical equipment and medical supplies with no copay, 20% coinsurance, and prior authorization requirements. Prosthetic devices are covered with no copay and 0% to 20% coinsurance, while diabetic equipment is partially covered with no copay and no coinsurance, excluding diabetic supplies and therapeutic shoes or inserts which are not covered.
Diagnostic and Radiological Services See details
PacificSource Medicare Explorer 6 (PPO) covers diagnostic and radiological services with prior authorization, featuring a $15 copay and 20% coinsurance for diagnostic procedures and tests, and a copay with no coinsurance for lab services. Diagnostic radiological and outpatient X-ray services require no copay, while therapeutic radiological services require a copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by PacificSource Medicare Explorer 6 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PacificSource Medicare Explorer 6 (PPO) covers cardiac rehabilitation services with no coinsurance, though some services are covered while standard cardiac ($35 copay), intensive cardiac ($35 copay), pulmonary ($15 copay), and SET for PAD ($25 copay) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PacificSource Medicare Explorer 6 (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $203 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
PacificSource Medicare Explorer 6 (PPO) partially covers other services, offering acupuncture for a $20 copay and no coinsurance up to 24 treatments annually, and annual wellness visits with no copay and no coinsurance. Over-the-counter items are covered with no copay and no coinsurance up to $25 every three months, though meal benefits and nicotine replacement therapy are not covered.
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