PacificSource Medicare was founded in Oregon in 1933 as a not-for-profit company, offers Medicare Advantage plans, and has more than 300,000 members throughout the Northwest.
According to the Kaiser Family Foundation (KFF), Medicare-approved insurance companies, such as PacificSource, provided Advantage plans to more than 24 million US citizens in 2020.
This article looks at the PacificSource Advantage plans and availability. It also looks at the coverage, benefits, and costs.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
PacificSource is a private healthcare insurance company that started in Oregon as the Pacific Hospital Association in 1933. The company now provides healthcare coverage to 500,000 members across the states of Idaho, Montana, Oregon, and Washington.
PacificSource offers Medicare Advantage plans with and without Part D prescription drug coverage, including several options with zero cost premiums.
PacificSource offers several Medicare Advantage plans, including Health Maintenance Organization (HMO), Health Maintenance Organization Point of Service (HMO-POS), and Preferred Provider Organization (PPO).
HMO plans
PacificSource HMO plans include Medicare Essentials 2 without Part D prescription drug coverage and MyCare Rx 40 including Part D.
When a person enrolls in an HMO plan, they agree to use the plan’s network of healthcare providers. They also choose a primary care doctor from within the network, who then coordinates health services and referrals to specialists.
If a person wants to use a healthcare provider from outside the network, they may have more costs, except in a medical emergency.
Medicare Essentials 2 (HMO) plan
This plan is available in certain counties in Oregon. In 2021, the monthly premium and the annual deductible are both zero, while the out-of-pocket maximum expense is $5,500. A person must use in-network providers.
My Care Rx 40 (HMO) plan
This plan is available in certain counties in Oregon.
The monthly premium in 2021 is zero. Out-of-pocket expenses in 2021 have an annual maximum of $4,950, and a person must use in-network providers.
HMO-POS plans
PacificSource HMO-POS plans include Medicare Essentials Choice Rx 14, and MyCare Choice Rx 24, both of which include prescription drugs (Part D) coverage.
With HMO-POS plans, people have the freedom to use healthcare services outside of their plan’s network. However, they must pay a higher copay or coinsurance to do so.
Medicare Essentials Choice Rx 14 plan (HMO-POS) plan
This plan is available in certain counties in Oregon.
In 2021, the monthly premium is $99.00 and the in-network out-of-pocket maximum is $5,500.
2021 MyCare Choice Rx 24 (HMO-POS) plan
This plan is available in certain counties in Idaho.
The monthly premium in 2021 is $35. Out-of-pocket expenses have an annual maximum of $5,500 in 2021 for in-network providers and no maximum for out-of-network services.
PPO plans
PacificSource PPO plans include Explorer 12 without the prescription drug (Part D) cover and Explorer Rx4, including Part D prescription drug coverage.
These plans use a network of healthcare providers, although a person can use services outside of the network, but may incur higher out-of-pocket expenses. However, a person does not need to select a primary care doctor or request referrals to see a specialist.
2021 Explorer 12 (PPO)
This plan is available in certain counties in Idaho.
The monthly premium and the annual deductible for 2021 are both zero. Out-of-pocket expenses in 2021 range from $3,500 for in-network providers to $10,000 for combined in-network and out-of-network providers.
2021 Explorer Rx 4 (PPO)
This plan is available in certain counties in Oregon.
The monthly premium in 2021 is $109, there is zero annual deductible, and the out-of-pocket expenses in 2021 range from $5,500 for in-network providers to $10,000 for combined in-network and out-of-network providers.
PacificSource Medicare Advantage plan include several costs:
- Plan premiums. Most Medicare Advantage plans have a monthly premium, which varies by location and plan. However, the PacificSource Explorer 12 PPO plan and Essentials 2 HMO plan do not have monthly premiums.
- Copays and coinsurance. When someone receives medical care, they pay either a copay or coinsurance amount, which may be higher if they use an out-of-network provider.
- Deductibles. The plan holder must pay this out-of-pocket amount before the plan provider begins to cover costs.
PacificSource provides an online tool to compare their various Medicare Advantage plans, along with showing approximate costs.
Here are some other example costs for PacificSource Medicare Advantage plans in Idaho, Oregon, and Montana.
| Plan | Location | Premium | Deductible | Doctor visit | Specialist visit |
| MyCare Choice Rx 24 (HMO-POS) Plan | Idaho | $35 | $125 | $0 | $35 |
| Explorer 12 (PPO) Plan | Idaho | $0 | $0 | $10 | $35 |
| MyCare Rx 39 (HMO) Plan | Oregon | $68 | $0 | $0 | $25 |
| MyCare 30 (HMO) | Montana | $0 | $0 | $0 | $30 |
PacificSource Medicare Advantage plans must cover the same services as original Medicare. Some plans may also include additional benefits, including
- routine vision care
- hearing exams
- optional add-on dental care
- gym membership and access to the Silver&Fit exercise program
- access to the 24-hour nurse line
- reimbursement for over-the-counter aspirin, calcium, and calcium-vitamin D products
- worldwide emergency medical coverage
- Part D Prescription Drug Coverage
Federally regulated Medicare is a health insurance program for older people and some younger people with disabilities.
The program has 4 parts:
- Part A provides hospital coverage.
- Part B is for medical insurance.
- Part C is also known as Medicare Advantage is an alternative to original Medicare.
- Part D provides coverage for prescription drugs.
PacificSource is a private insurance company offering Medicare Advantage plans to residents of Idaho, Montana, Oregon, and Washington. People in these four states can choose from HMO, HMO-POS, and PPO options.
PacificSource Advantage plans cover at least the same healthcare services as original Medicare plus additional benefits, including gym membership, vision and hearing exams, 24-hour nurse line, and coverage for some over-the-counter medication.
2021 Medicare Advantage Plan Services for
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS). (2020).
https://www.medicarehelp.org/2021-medicare-advantage/ma/pacificsource-medicare-essentials-choice-rx-14-hmo-pos-H3864-014#
2021 Essentials 2 (HMO) plan. (2020).
https://medicare.pacificsource.com/Find/2021/CO/Essentials2
2021 MyCare Choice Rx 24 (HMO-POS) plan. (2020).
https://medicare.pacificsource.com/Members/2021/SID/MyCareChoiceRx24
2021 MyCare Rx 39 (HMO) plan. (2020).
https://medicare.pacificsource.com/Find/2021/PD/MyCareRx39
2021 Explorer 12 (PPO) plan. (2020).
https://medicare.pacificsource.com/Find/2021/NI/Explorer12
2021 Explorer Rx 4 (PPO) plan. (2020).
https://medicare.pacificsource.com/Find/2021/LN/ExplorerRx4#SA
2021 MyCare 30 (HMO) Plan. (2021).
https://medicare.pacificsource.com/Find/2021/SCM/MyCare30
2021 My Care Rx 40 (HMO) plan. (2020).
https://medicare.pacificsource.com/Find/2021/PD/MyCareRx40
PacificSource. (n.d.).
https://pacificsource.com/
PacificSource. (n.d.)
https://pacificsource.com/mission
Understanding Medicare Advantage Plans. (n.d).
https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf