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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.

MyCare Choice 30
(HMO-POS)

View Plan

$0 per month

MyCare Rx 40
(HMO)

View Plan

$0 per month

MyCare Choice Rx 34
(HMO-POS)

View Plan

$10 per month
Plan Highlights
Medical Coverage
Prescription Coverage
Vision Coverage
Dental Coverage
One Pass® Healthy Aging and Fitness Program
What you pay when you see an in-network provider:
Primary Care Provider $0 $0 $0
Specialist $0 $30 $25
Urgent Care $55 $55 $55
Emergency Room $120 $120 $120

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.