PacificSource Medicare v
PacificSource Medicare 2019 Plan Changes • Medicare – The service area has expanded to include Clackamas, Multnomah, and Washington counties and Clark County, Washington. – Now $0 copay for Silver& Fit Membership and home fitness kits – The Prescription Drug out-of-pocket maximum per person per calendar year is $5,100. • Non-Medicare Core Value and Select Value Plans – These plans are no longer available through PacificSource
PacificSource Medicare Medicare Advantage Plan
The Value of PacificSource Medicare Advantage and the PHIP Partnership Enhanced Medical Benefits • No deductibles • Low annual out-of-pocket maximum • $0 co-pay (100% coverage) for: ‒ Lab services, home health care, skilled nursing facilities • Lower co-pays for: ‒ Hospital stays ‒ Physical therapy ‒ Outpatient surgery ‒ Doctor office visits ‒ Advanced imaging ‒ Emergency room and (MRI, CT, PET scans) urgent care
PacificSource Enrollment Service Area Oregon : Clackamas; Coos; Crook; Curry; Deschutes; Grant; Hood River; Jefferson; Klamath: 97731, 97733, 97737, 97736; Lake: 97638 , 97641, 97735, 97739; Lane; Multnomah; Sherman; Wasco; Washington, Wheeler Washington : Clark
How Our Medicare Advantage Plan Works • An HMO plan – Choose a primary care provider (PCP) – Freedom to see specialists without a referral • Use network providers for most services – Plan is accepted by a broad network of local providers, including OHSU and Legacy Health System • Travel coverage – U.S. and worldwide
PacificSource Medicare Advantage Benefit Coverage Medicare Advantage Essentials RX 803 Member Responsibility Deductible None Out-of-Pocket Maximum $3,400 per individual Primary Care Office Visit $15 copay Specialist Office Visit $20 copay Inpatient Hospitalization $125 copay per day $500 maximum per admit Outpatient Surgery $125 copay Lab Tests $0 X-ray 10% Pharmacy 40% of charge up to $250 maximum per 31-day supply Pharmacy Out-of-Pocket Maximum $5,100 per individual
PacificSource Medicare Advantage Emergency and Travel Benefits Medicare Advantage Essentials Service RX 803 Urgent Care $20 copay (Worldwide coverage) Emergency Room $50 copay (Worldwide coverage) Ambulance - ground or air $50 copay (Worldwide coverage)
PacificSource Medicare Advantage Special Attributes Extra Benefits Included (not covered by Medicare) • Annual routine physicals - $0 copay (including lab tests) • Annual routine hearing exams • $250 hearing aid reimbursement • Discounts on name brand hearing aids • Routine eye exams • $100 reimbursement for eyeglasses or contacts • Annual Silver & Fit gym membership
PacificSource Medicare Advantage Personal Service Quality of service • Live telephone answering • Customer service team based in Bend and Boise – Available by phone 7am-8pm • Walk-in assistance available in Bend and Springfield offices, no appointment necessary • Nurse case managers and member support specialists to assist with complex medical and other critical needs • 24-Hour NurseLine
Online Resources for Members InTouch at Medicare.PacificSource.com Secure online member portal • Search your claims • Order new ID cards • View your plan materials and benefits • View your EOBs • Elect to receive plan materials electronically
myPacificSource FREE Mobile App • Access your member ID card • Access your office visit copays and out-of-pocket maximum • Find a nearby provider or hospital • Call the 24-hour NurseLine Just open your app store, search for “PacificSource Health Plans.” and download for FREE.
With the Silver&Fit Program, you have the following choices available at no cost to you: 1. A fitness center membership: Choose a Silver&Fit fitness center/YMCA near you that takes part in the program OR 2. A Home Fitness Program: Choose 2 home fitness kits per year (34 to choose from) To search for a participating fitness center/YMCA go to SilverandFit.com
PacificSource Medicare Part D Prescription Drug Plan
Pharmacy Network Benefit PacificSource Formulary • Includes a broad list of name brand and generic medications • View Formulary on our website: Medicare.PacificSource.com Medication Therapy Management (MTM) Program A free service that can: • Improve the management of your health conditions, • Identify potential medication conflicts, • Look for opportunities to lower your drug costs, and Pharmacy Network Network Pharmacies Include* Over 68,000 in-network • Albertsons Fred Meyer CVS at Target pharmacies nationwide Bi-Mart Rite Aid Walgreens Costco Safeway Walmart ShopKo Sisters Drug Includes many independent pharmacies *Not all contracted network pharmacies are listed. Pharmacies contracted with your health plan may change at any time. Your health plan will notify you if your pharmacy is no longer included in the network. Please contact your health plan for more details .
Recommend
More recommend
