PacificSource Medicare Essentials Rx 27 (HMO)

Medicare Plan Details (2022 Plan)


Monthly Premium

 

by PacificSource Medicare
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 4.0
out of 5 stars

Ready to Enroll Online?


Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

 

$40
$6
$34
$0
$6,700 In-network
No
Yes
Yes
Yes

Doctor Services

$0-19 copay per visit
$0-39 copay per visit

Tests, labs, & imaging

$20 copay or 20% coinsurance
$0-25 copay or 20% coinsurance
$0-320 copay
$0-20 copay
$90 copay per visit (always covered)
$65 copay per visit (always covered)

Hospital Services

$395 per day for days 1 through 4
$0 per day for days 5 through 90
$0-395 copay per visit

Skilled nursing facility

$0 per day for days 1 through 20
$188 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

$300 copay

Therapy services

$40 copay
$40 copay

Mental health services

$40 copay
$40 copay
$40 copay
$40 copay

Opioid treatment services

Covered

Other services

20% coinsurance per item
0-20% coinsurance per item
20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$8.00 copay


Generic drugs :
$3.95 copay or 5% (whichever costs more)

Brand-name drugs :
$9.85 copay or 5% (whichever costs more)

Generic$17.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug32%
Specialty Tier26%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

20% coinsurance
20% coinsurance

Hearing

$50 copay
$0 copay
$599-999 copay

Preventive Dental

$0 copay
$0 copay
Not covered
$0 copay

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

$50 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
 4
 4
 3
 4
 4
 5
 4
 4
 5
 4
 4

When Can I Sign Up for Medicare?

Enter your birthday month and year to learn when you can sign up for different Medicare plan options.

 

 


Ready to Enroll Online?

Advertisement

Medicare Health Plans

Get Advice & Sign Up Help
TTY 711

Speak with a Licensed Insurance Agent

Medicare65quote

No obligation to enroll. Find your plan online or speak with a licensed insurance agent to get help signing up for the right plan for you! Plan availability depends on your location. Licensed agents may not be able to provide assistance for all plans shown on this site.

Related Articles
Best Oregon Medicare Advantage Health Insurance Companies for 2022

In this article we rank Oregon Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.

Read more →

New Oregon Medicare Advantage Health Insurance Companies for 2022

The Medicare landscape in Oregon is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in Oregon.

Read more →