PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) in Ada, Idaho (2023)
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) in Ada County, Idaho costs $35/mo. This affordable Regional PPO plan (H3864-024) is a top choice for those living in Ada County with a $100 prescription deductible and out-of-pocket limits at $5,500. Learn more about Medicare Part C by AARP in Ada County, Idaho below.
UPDATED: Sep 20, 2023
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UPDATED: Sep 20, 2023Fact Checked
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3 out of 5 stars* for plan year 2024
Plan ID: H3864-024
What You Need to Know:
- PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) is a Medicare Advantage Health Maintenance Organization Local HMO 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 $35, which does not include your monthly Medicare Part B premium.
- The annual deductible for this health plan is $100 (Tier 1 and 2 excluded from the Deductible.).
- The plan includes an out-of-pocket maximum of $5,500 per year (in-network).
- PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $100 (Tier 1 and 2 excluded from the Deductible.).
- This plan's Part D Initial Coverage Limit is $35.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$35
Monthly Premium
| Medicare Plan Features | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Monthly Premium: | $35.00 | ||||||||
| Part C Premium: | $0 | ||||||||
| Monthly Premium: | Part C Premium: | Part D Drug Premium: | Part D Supplemental Premium: | Total Part D Premium: | Drug Deductible: | Tiers with No Deductible: | |||
| $35.00 | $0 | $35.00 | $0 | $35.00 | $100.0 | 1.0 | |||
| Gap Coverage: | Yes | ||||||||
| Benchmark: | not below the regional benchmark | ||||||||
| Type of Medicare Health: | Enhanced Alternative | ||||||||
| Health Plan Type: | Local HMO | ||||||||
| Similar Plan: | H3864-027 | ||||||||
| Special Needs Type: | NULL | ||||||||
| Chronic Condition: | NULL | ||||||||
| Additional Gap Coverage: | Yes, some additional gap coverage. | ||||||||
| Maximum Out-of-Pocket Limit for Parts A & B (Moop): | $5,500 | ||||||||
| Annual Deductible: | $100 (Tier 1 and 2 excluded from the Deductible.) | ||||||||
| Annual Initial Coverage Limit ICL: | $4,130 | ||||||||
| Number of Members enrolled in this plan in Ada, Idaho: | Plans Summary Star Rating: | Customer Service Rating: | Drug Cost Rating: | ||||||
| 703 members | 4 out of 5 Stars. | 3 out of 5 Stars. | 4 out of 5 Stars. | ||||||
| Plan Offers Mail Order: | Yes | ||||||||
| Plan Health Benefits | |||||||||
| Total # of Formulary Drugs: | 3,814 drugs | ||||||||
| 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 | ||||||
| $0.00 | $35.00 | $0.00 | $35.00 | ||||||
| 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 | |||
| $0.00 | $26.20 | $26.20 | $17.50 | $17.50 | $8.70 | $8.70 | |||
| 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) |
| 201 | $3.00 | 1871 | $12.00 | 330 | $37.00 | 488 | 31% | 764 | 31% |