PacificSource Medicare Essentials 2 (HMO)
Medicare Plan Details
2021 Plan
Monthly Premium
| (select county for price) |
by PacificSource Medicare
Additional Coverage
Hearing
Vision
Overall Government Star Rating
4.0out of 5 stars
State: Oregon
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B
Plan Details
$0
$0
$0
$0
$5,500 In-network
No
Yes
Yes
No
Medical Benefits
Doctor Services
$0-10 copay per visit
$0-40 copay per visit
Tests, labs, & imaging
$15 copay or 20% coinsurance
$0-15 copay or 20% coinsurance
$190-310 copay
$0-15 copay
$90 copay per visit (always covered)
$40 copay per visit (always covered)
Hospital Services
$325 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 6 through 90
$0-325 copay per visit
Skilled nursing facility
$0 per day for days 1 through 20
$184 per day for days 21 through 100
$184 per day for days 21 through 100
Preventive services
$0 copay
Ambulance
$300 copay
Therapy services
$35 copay
$35 copay
Mental health services
$25 copay
$25 copay
$25 copay
$25 copay
Opioid treatment services
Covered
Other services
20% coinsurance per item
0-20% coinsurance per item
$0 copay
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Part B Drugs
20% coinsurance
20% coinsurance
Extra Benefits
Hearing
$40 copay
$0 copay
$699-999 copay
Preventive Dental
Not covered
Not covered
Not covered
Not covered
Comprehensive dental
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Vision
$40 copay
$0 copay
$0 copay
$0 copay
$0 copay
Not covered
Other benefits
Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
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