PacificSource Medicare Medicare Plan Hearing Aid Benefits

44,796 Total Members

OTC Supplemental Benefits Prescription Hearing Aid Coverage
Company Plan name Plan type OTC Supplement OTC Rolls Over? Annual OTC Supplement Coverage? Covered Amount Covers OTC Aids? Coinsurance? Copay? Prior Authorization? Need Referral? Enrollees
PacificSource Medicare PacificSource Medicare Essentials Choice Rx 36 (HMO-POS)
H3864-036-0 		HMOPOS $45 per Quarter No $180 Yes No No Yes No No 8,774
PacificSource Medicare PacificSource Dual Care (HMO D-SNP)
H3864-043-0 		HMO $500 per Month No $0 No 6,160
PacificSource Medicare PacificSource Medicare Explorer Rx 11 (PPO)
H4754-011-0 		Local PPO $50 per Quarter No $200 Yes No No Yes No No 4,989
PacificSource Medicare PacificSource Medicare MyCare Choice Rx 24 (HMO-POS)
H3864-024-0 		HMOPOS $50 per Quarter No $200 Yes No No Yes No No 3,845
PacificSource Medicare PacificSource Medicare Essentials Choice Rx 14 (HMO-POS)
H3864-014-0 		HMOPOS $25 per Quarter No $100 Yes No No Yes No No 3,763
PacificSource Medicare PacificSource Medicare MyCare Rx 40 (HMO)
H3864-040-0 		HMO $75 per Quarter No $300 Yes No No Yes No No 2,791
PacificSource Medicare PacificSource Medicare Essentials Choice 2 (HMO-POS)
H3864-002-0 		HMOPOS $100 per Quarter No $400 Yes No No Yes No No 2,261
PacificSource Medicare PacificSource Medicare Essentials Rx 27 (HMO)
H3864-027-0 		HMO $45 per Quarter No $180 Yes No No Yes No No 1,819
PacificSource Medicare PacificSource Medicare MyCare Rx 32 (HMO)
H3864-032-0 		HMO $50 per Quarter No $200 Yes No No Yes No No 1,408
PacificSource Medicare PacificSource Medicare MyCare Choice Rx 34 (HMO-POS)
H3864-034-0 		HMOPOS $75 per Quarter No $300 Yes No No Yes No No 1,273
PacificSource Medicare PacificSource Medicare Essentials Rx 41 (HMO)
H3864-041-0 		HMO $100 per Month No $0 Yes No No Yes No No 1,246
PacificSource Medicare PacificSource Medicare Essentials Rx 803 (HMO)
H3864-803-0 		HMO No $0 No 1,146
PacificSource Medicare PacificSource Medicare Explorer Rx 9 (PPO)
H4754-009-0 		Local PPO $100 per Month No $0 Yes No No Yes No No 1,042
PacificSource Medicare PacificSource Medicare MyCare Choice Rx 29 (HMO-POS)
H3864-029-0 		HMOPOS $50 per Quarter No $200 Yes No No Yes No No 786
PacificSource Medicare PacificSource Medicare Explorer 12 (PPO)
H4754-012-0 		Local PPO $200 per Quarter No $800 Yes No No Yes No No 751
PacificSource Medicare PacificSource Medicare Essentials Rx 6 (HMO)
H3864-006-0 		HMO $25 per Quarter No $100 Yes No No Yes No No 696
PacificSource Medicare PacificSource Medicare Explorer 6 (PPO)
H4754-006-0 		Local PPO $100 per Quarter No $400 Yes No No Yes No No 684
PacificSource Medicare PacificSource Medicare Explorer Rx 4 (PPO)
H4754-004-0 		Local PPO $100 per Month No $0 Yes No No Yes No No 516
PacificSource Medicare PacificSource Medicare Essentials Choice Rx 42 (HMO-POS)
H3864-042-0 		HMOPOS $25 per Quarter No $100 Yes No No Yes No No 262
PacificSource Medicare PacificSource Medicare Explorer Rx 7 (PPO)
H4754-007-0 		Local PPO $100 per Month No $0 Yes No No Yes No No 226
PacificSource Medicare PacificSource Medicare Explorer 8 (PPO)
H4754-008-0 		Local PPO $200 per Quarter No $800 Yes No No Yes No No 169
PacificSource Medicare PacificSource Medicare MyCare Choice 30 (HMO-POS)
H3864-030-0 		HMOPOS $200 per Quarter No $800 Yes No No Yes No No 105
PacificSource Medicare PacificSource Medicare Explorer Rx 17 (PPO)
H4754-017-0 		Local PPO $100 per Month No $0 Yes No No Yes No No 84

Plan Claims Contact Information

Organization Name: Pacific Source Medicare
Contact Name: Jane Hannabach
Title: VP, Government Operations
Phone: 1-541-330-2530
Email: Jane.Hannabach@pacificsource.com
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