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  3. 97058 Change

How to use this tool to find the best plan for you

  • To view details of a single plan, click the plan name in the table below.
  • To see a full side-by-side plan comparison:
    1. Check the "Compare" boxes of the plans you wish to compare.
    2. Click the "Compare Plan Benefits" button at the top or bottom of the page.

Essentials
Choice 2
(HMO-POS)

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$0 per month

Essentials
Choice Rx 36
(HMO-POS)

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$0 per month

Essentials
Rx 27
(HMO)

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$32 per month

Essentials
Choice Rx 14
(HMO-POS)

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$90 per month

Essentials
Rx 6
(HMO)

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$200 per month

Dual
Care**
(HMO D-SNP)

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$0 per month
Plan Highlights
Medical Coverage
Prescription Coverage
Vision Coverage
Dental Coverage
Silver&Fit® Healthy Aging and Fitness Program
Assist America® Global Emergency Services
Telehealth
Optional Supplemental Dental benefits available on most plans for an additional monthly premium
What you pay when you see an in-network provider:
Primary Care Provider $0 $0 $19 $10 $0 $0
Specialist $0 $35 $39 $35 $15 $0
Urgent Care $60 $60 $60 $60 $60 $0
Emergency Room $120 $120 $120 $120 $120 $0
* This plan has special enrollment requirements. To be eligible, you must qualify for full Medicaid benefits and Medicare. Cost shares, benefits, premiums, and deductibles listed reflect Medicare and Medicaid coverage. Your costs may vary if your Medicaid eligibility category and/or the level of Extra Help you receive changes.

Out-of-Network/non-contracted providers are under no obligation to treat PacificSource members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our Customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.