PacificSource Dual Care (HMO D-SNP)
Medicare Plan Details (2023 Plan)
Monthly Premium
by PacificSource Medicare
Additional Coverage
Overall Government Star Rating
3.5Ready 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
Plan Details
Medical Benefits
Doctor Services
Tests, labs, & imaging
Hospital Services
Skilled nursing facility
Preventive services
Ambulance
Therapy services
Mental health services
Opioid treatment services
Other services
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $0.00 copay |
Brand-name drugs :
| |
| Generic | $20.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | 34% | ||
| Specialty Tier | 25% | ||
| 1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. | |||
Part B Drugs
Extra Benefits
Hearing
Preventive Dental
Comprehensive dental
Vision
Other benefits
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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