HMO Not Available SNP Includes Rx
Plan Details
Plan NamePacificSource Medicare MyCare Rx 40 (HMO)
OrganizationPacificSource Medicare
Legal EntityPACIFICSOURCE COMMUNITY HEALTH PLANS
Plan TypeHMO
Service AreaSelect Oregon and Washington Counties
Contract IDH3864
Plan ID040
In-Network MOOP$5,800
In-Network Deductible$500
Prescription Drug CoverageYes (Part D Included)
About This Plan
PacificSource Medicare MyCare Rx 40 (HMO) is a HMO Medicare plan offered by PacificSource Medicare (PACIFICSOURCE COMMUNITY HEALTH PLANS). This plan is available to eligible Medicare beneficiaries in Select Oregon and Washington Counties.
This is a Special Needs Plan (SNP) designed for Not Available beneficiaries. This plan includes Medicare Part D prescription drug coverage.
The in-network maximum out-of-pocket (MOOP) for this plan is $5,800, which is the most you would pay for covered services in a plan year. After reaching this amount, the plan pays 100% of covered services.
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