PacificSource Medicare v PacificSource Medicare 2019 Plan Changes - - PowerPoint PPT Presentation
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
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– 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.
– These plans are no longer available through PacificSource
‒ Lab services, home health care, skilled nursing facilities
‒ Hospital stays ‒ Physical therapy ‒ Outpatient surgery ‒ Doctor office visits ‒ Advanced imaging (MRI, CT, PET scans) ‒ Emergency room and urgent care
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
– Choose a primary care provider (PCP) – Freedom to see specialists without a referral
– Plan is accepted by a broad network of local providers, including OHSU and Legacy Health System
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
(Worldwide coverage)
(Worldwide coverage)
(Worldwide coverage)
Boise – Available by phone 7am-8pm
Springfield offices, no appointment necessary
specialists to assist with complex medical and
materials and benefits
plan materials electronically
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
Part D Prescription Drug Plan
*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.
PacificSource Formulary
Medication Therapy Management (MTM) Program A free service that can:
Pharmacy Network
pharmacies nationwide
Network Pharmacies Include*
Albertsons Fred Meyer CVS at Target Bi-Mart Rite Aid Walgreens Costco Safeway Walmart ShopKo Sisters Drug Includes many independent pharmacies