PacificSource Medicare Essentials Rx 6 (HMO)
Available to residents of Crook County, OR for 2026. Contract H3864, plan 006, segment 0.
Plan details
| Monthly drug premium | $105.90 |
|---|---|
| Drug deductible | $99.00Tier 1 and 2 exempt |
| Plan type | Medicare Advantage |
| Contract / plan | H3864-006-0 |
| Offered by | PacificSource Medicare |
| Parent organization | PacificSource |
| Formulary drugs | 3,742 |
CMS star ratings
- Overall
- 3.5 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H3864 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $12.00 |
| Tier 3 | 24% |
| Tier 4 | 28% |
| Tier 5 | 31% |
Also available in 6 other OR counties
Plan facts come from the CMS quarterly prescription drug plan public use files.