4

4 out of 5 stars* for plan year 2024

Plan ID: H4754-006

What You Need to Know:

  • PacificSource Medicare Explorer 6 (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO * plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is no drug coverage.
  • The plan includes an out-of-pocket maximum of $3,500 per year (in-network).
  • PacificSource Medicare Explorer 6 (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is no drug coverage.
  • This plan's Part D Initial Coverage Limit is .

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
Part C Premium: NULL
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$0 NULL NULL NULL NULL NULL NULL
Gap Coverage: NULL
Benchmark: NULL
Type of Medicare Health: NULL
Health Plan Type: Local PPO *
Similar Plan: H4754-007
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: NULL
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $3,500
Annual Deductible: no drug coverage
Annual Initial Coverage Limit ICL: NULL
Number of Members enrolled in this plan in Ada, Idaho: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
169 members 3.5 out of 5 Stars. 4 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: NULL
Plan Health Benefits
Total # of Formulary Drugs: NULL
Number of Members Enrolled in this Plan in Ada, Idaho: NULL
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
NULL NULL NULL NULL
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
NULL NULL NULL NULL NULL NULL NULL
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
NULL NULL NULL NULL NULL NULL NULL NULL NULL NULL

Other Medicare Advantage Plans in Ada, Idaho

Plan Name Type Premium MOOP Rx Deduct. Rating
True Blue Rx Gem (HMO) (2023)Local HMO$5,800$190
3
True Blue no Rx (HMO) (2023)Local HMO *$3,000$-
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True Blue Rx Essentials (HMO) (2023)Local HMO$5,900$300
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AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$5,400$-
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PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) (2023)Local HMO$5,500$100
3
PacificSource Medicare MyCare Rx 32 (HMO) (2023)Local HMO$5,500$0
3
Regence MedAdvantage + Rx Primary (PPO) (2023)Local PPO$5,500$200
5
Humana Honor (PPO) (2023)Local PPO *$5,000$-
4
Regence MedAdvantage + Rx Classic (PPO) (2023)Local PPO$5,500$200
5
MediGold Medical Only (HMO) (2023)Local HMO *$3,900$-
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Regence Blue MedAdvantage HMO (HMO) (2023)Local HMO$5,500$200
5
Regence Blue MedAdvantage HMO Plus (HMO) (2023)Local HMO$5,200$110
5
SelectHealth Advantage Essential (HMO) (2023)Local HMO$6,700$150
2
UnitedHealthcare Medicare Advantage Assure (PPO) (2023)Local PPO$7,550$445
5
SelectHealth Advantage Enhanced (HMO) (2023)Local HMO$5,900$0
2
MediGold Essential Care (HMO) (2023)Local HMO$5,500$0
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AARP Medicare Advantage Choice Plan 1 (PPO) (2023)Local PPO$4,700$190
5
MediGold Classic Preferred (HMO) (2023)Local HMO$3,900$0
New plan - not yet rated.
MediGold True Advantage (HMO) (2023)Local HMO$4,500$0
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AARP Medicare Advantage Choice Plan 2 (PPO) (2023)Local PPO$3,900$175
5
AARP Medicare Advantage (HMO) (2023)Local HMO$4,900$200
5
True Blue Rx Option I (HMO) (2023)Local HMO$6,500$0
3
AARP Medicare Advantage Focus (HMO) (2023)Local HMO$4,900$100
5
Molina Medicare Choice Care (HMO) (2023)Local HMO$5,000$100
5
Aetna Medicare Elite Plan (HMO) (2023)Local HMO$6,900$0
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Aetna Medicare Value Plan (HMO) (2023)Local HMO$7,550$0
New plan - not yet rated.
True Blue Rx Option II (HMO) (2023)Local HMO$6,400$250
3
AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$6,700$200
5
Humana Community (HMO) (2023)Local HMO$5,500$100
5
HumanaChoice H5216-044 (PPO) (2023)Local PPO$6,000$200
4
HumanaChoice H5216-132 (PPO) (2023)Local PPO$5,500$200
4
True Blue Rx (HMO) (2023)Local HMO$6,200$125
3
Humana Gold Plus H5619-077 (HMO) (2023)Local HMO$5,000$150
4
Aetna Medicare Select Plan (PPO) (2023)Local PPO$7,000$0
5
Aetna Medicare Choice Plan (PPO) (2023)Local PPO$7,550$0
5
True Blue Rx Preferred (HMO) (2023)Local HMO$5,900$185
3
Regence Valiance (PPO) (2023)Local PPO *$5,900$-
5
Medicare Advantage Plans by PacificSource Medicare
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) (2023)Local HMO$5,500$100
3
PacificSource Medicare MyCare Rx 32 (HMO) (2023)Local HMO$5,500$0
3

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