A non-government entity
PacificSource Medicare Explorer Rx 18 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PacificSource Medicare Explorer Rx 18 (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 Rx 18 (PPO) in 2025, please refer to our full plan details page.
PacificSource Medicare Explorer Rx 18 (PPO) is a PPO plan offered by PacificSource available for enrollment in 2025 to people living in Select Idaho and Montana 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 Rx 18 (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PacificSource Medicare Explorer Rx 18 (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 Rx 18 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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.
This plan has a $499.00 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 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 Rx 18 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The PacificSource Medicare Explorer Rx 18 (PPO) plan has a $499 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs, you will pay a $12 copay at a preferred pharmacy. For preferred brand drugs, you will pay 29% coinsurance at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The PacificSource Medicare Explorer Rx 18 (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services, and emergency care. You'll have a copay for primary care visits, specialist visits, and some therapies, while preventive services are covered with no copay. This plan also includes coverage for hearing and vision services with copays, dental services with a yearly maximum, and home health services with no copay. Additionally, you'll find coverage for ambulance services, diagnostic services, and medical equipment, with varying copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute care with a $425 copay for days 1-7 and no copay for days 8-90, and psychiatric care with a $325 copay for days 1-7 and no copay for days 8-90. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered. Additional days and non-Medicare-covered stays for inpatient hospital psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $425, and observation services with a $425 copay. Additionally, this plan covers Ambulatory Surgical Center (ASC) Services with no copay, and outpatient substance abuse services with a $40 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the PacificSource Medicare Explorer Rx 18 (PPO) plan, with a $35 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PacificSource Medicare Explorer Rx 18 (PPO) plan, with all ambulance services requiring prior authorization. Ground and Air Ambulance Services have a $350 copay, and there is 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 under the PacificSource Medicare Explorer Rx 18 (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services has a $55 copay, and Worldwide Emergency Transportation has a $350 copay; all other services have no coinsurance.
Primary Care See details
Primary Care benefits include coverage for primary care physician services with a copay between $0 and $10, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, and mental health specialty services with a $40 copay. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a copay between $0 and $40. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. Kidney Disease Education Services are covered with 20% coinsurance. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, 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 include coverage for hearing exams with a $40 copay, and routine hearing exams, limited to one per year, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $599 and $999 for two hearing aids per year, while prescription hearing aids for the inner, outer, and over-the-ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for routine eye exams once per year, Other Eye Exam Services, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, all with no copay. Eyewear has a combined maximum benefit of $200 every two years, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $40 copay, and other dental services with a $775 maximum benefit per year, including Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery are covered with 50% coinsurance, while Maxillofacial Prosthetics and Orthodontics 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 and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PacificSource Medicare Explorer Rx 18 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 0-20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Equipment is covered with coinsurance of 20% for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the PacificSource Medicare Explorer Rx 18 (PPO) plan. 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 at most $430, 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 Rx 18 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but all of the sub-services including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for some Cardiac and Pulmonary Rehabilitation Services; however, the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the PacificSource Medicare Explorer Rx 18 (PPO) plan. There is 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 with the PacificSource Medicare Explorer Rx 18 (PPO) plan include an annual allowance of $100 for over-the-counter items. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved