Plans for PacificSource Medicare
41,124 Total Members
Prescription Hearing Aid Coverage | ||||||||||||
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Company | Plan name | Plan type | OTC Supplement | OTC Rolls Over? | Annual OTC Supplement | Coverage? | Covered Amount | Coinsurance? | Copay? | Prior Authorization? | Need Referral? | Enrollees |
PacificSource Medicare |
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) H3864-036-0 |
HMOPOS | $25 per Quarter | No | $100 | Yes | No | Yes | No | No | 5,925 | |
PacificSource Medicare |
PacificSource Dual Care (HMO D-SNP) H3864-043-0 |
HMO | $200 per Quarter | No | $800 | No | 5,201 | |||||
PacificSource Medicare |
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) H3864-014-0 |
HMOPOS | $25 per Quarter | No | $100 | Yes | No | Yes | No | No | 4,310 | |
PacificSource Medicare |
PacificSource Medicare Explorer Rx 11 (PPO) H4754-011-0 |
Local PPO | $25 per Quarter | No | $100 | Yes | No | Yes | No | No | 4,282 | |
PacificSource Medicare |
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) H3864-024-0 |
HMOPOS | $25 per Quarter | No | $100 | Yes | No | Yes | No | No | 4,092 | |
PacificSource Medicare |
PacificSource Medicare MyCare Rx 40 (HMO) H3864-040-0 |
HMO | $25 per Quarter | No | $100 | Yes | No | Yes | No | No | 2,803 | |
PacificSource Medicare |
PacificSource Medicare Essentials Rx 27 (HMO) H3864-027-0 |
HMO | $45 per Quarter | No | $180 | Yes | No | Yes | No | No | 2,426 | |
PacificSource Medicare |
PacificSource Medicare Essentials Choice 2 (HMO-POS) H3864-002-0 |
HMOPOS | $150 per Quarter | No | $600 | Yes | No | Yes | No | No | 2,225 | |
PacificSource Medicare |
PacificSource Medicare Essentials Rx 41 (HMO) H3864-041-0 |
HMO | $100 per Month | No | $0 | Yes | No | Yes | No | No | 1,350 | |
PacificSource Medicare |
PacificSource Medicare MyCare Rx 32 (HMO) H3864-032-0 |
HMO | $25 per Quarter | No | $100 | Yes | No | Yes | No | No | 1,312 | |
PacificSource Medicare |
PacificSource Medicare Essentials Rx 803 (HMO) H3864-803-0 |
HMO | No | $0 | No | 1,184 | ||||||
PacificSource Medicare |
PacificSource Medicare Explorer Rx 9 (PPO) H4754-009-0 |
Local PPO | $100 per Month | No | $0 | Yes | No | Yes | No | No | 1,140 | |
PacificSource Medicare |
PacificSource Medicare Essentials Rx 6 (HMO) H3864-006-0 |
HMO | $25 per Quarter | No | $100 | Yes | No | Yes | No | No | 790 | |
PacificSource Medicare |
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) H3864-029-0 |
HMOPOS | $50 per Quarter | No | $200 | Yes | No | Yes | No | No | 746 | |
PacificSource Medicare |
PacificSource Medicare Explorer 6 (PPO) H4754-006-0 |
Local PPO | $150 per Quarter | No | $600 | Yes | No | Yes | No | No | 722 | |
PacificSource Medicare |
PacificSource Medicare Explorer 12 (PPO) H4754-012-0 |
Local PPO | $150 per Quarter | No | $600 | Yes | No | Yes | No | No | 689 | |
PacificSource Medicare |
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) H3864-034-0 |
HMOPOS | $25 per Quarter | No | $100 | Yes | No | Yes | No | No | 622 | |
PacificSource Medicare |
PacificSource Medicare Explorer Rx 4 (PPO) H4754-004-0 |
Local PPO | $100 per Month | No | $0 | Yes | No | Yes | No | No | 535 | |
PacificSource Medicare |
PacificSource Medicare Explorer Rx 7 (PPO) H4754-007-0 |
Local PPO | $100 per Month | No | $0 | Yes | No | Yes | No | No | 244 | |
PacificSource Medicare |
PacificSource Medicare Essentials Choice Rx 42 (HMO-POS) H3864-042-0 |
HMOPOS | $25 per Quarter | No | $100 | Yes | No | Yes | No | No | 195 | |
PacificSource Medicare |
PacificSource Medicare Explorer 8 (PPO) H4754-008-0 |
Local PPO | $100 per Quarter | No | $400 | Yes | No | Yes | No | No | 172 | |
PacificSource Medicare |
PacificSource Medicare Explorer Rx 17 (PPO) H4754-017-0 |
Local PPO | $100 per Month | No | $0 | Yes | No | Yes | No | No | 83 | |
PacificSource Medicare |
PacificSource Medicare MyCare Choice 30 (HMO-POS) H3864-030-0 |
HMOPOS | $200 per Quarter | No | $800 | Yes | No | Yes | No | No | 76 |