Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
PacificSource Medicare Valley Select Rx, 2027
H3864Contract036Plan
HMO-POS · 1 county in Oregon
Run by PacificSource Community Health Plans (contract H3864), sold as PacificSource Medicare, owned by PacificSource
PacificSource Medicare Valley Select Rx (H3864-036) costs $49 a month in 2027, up $21 from 2026, with an in-network out-of-pocket limit of $7,150 ($6,500 in 2026). In 2026 it was called PacificSource Medicare Essentials Choice Rx 36. It leaves 7 counties it served in 2026, where 16,156 of its members lived; they choose another plan for 2027 (the counties are listed below).
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Plan name | PacificSource Medicare Essentials Choice Rx 36 | PacificSource Medicare Valley Select Rx | renamed |
| Monthly premium | $28 | $49 | ▲up $21 |
| In-network out-of-pocket limit | $6,500 | $7,150 | ▲up $650 |
| Drug deductible | $499 | $600 | ▲up $101 |
| Emergency room | $120 copay | $130 copay | ▲up $10 |
| Hospital stay, in network | $425 a day for days 1–7, then $0 a day for days 8–90 | $495 a day for days 1–5, then $0 a day for days 6–90 | ▲up $350for a 5-day stay |
| Skilled nursing facility, in network | $0 a day for days 1–20, then $203 a day for days 21–100 | $0 a day for days 1–20, then $221 a day for days 21–100 | ▲up $180for a 30-day stay |
| Eyewear, yearly limit | $100 a year | $67.50 a year | ▼down $32.50 |
| Over-the-counter items, yearly | $60 a year | $80 a year | ▲up $20 |
| Counties served | 8 | 1 | ▼down 7 |
| Drug tier 4, non-preferred drug | 25% of the cost | 29% of the cost | ▲up 4 points |
| Drug tier 5, specialty tier | 27% of the cost | 26% of the cost | ▼down 1 point |
| 10 lines do not change | |||
| Part B premium reduction, monthly | none | none | no change |
| Primary care visit | $0 copay | $0 copay | no change |
| Specialist visit | $0 copay | $0 copay | no change |
| Medical deductible, in network | none | none | no change |
| Ground ambulance, in network | $350 copay | $350 copay | no change |
| Comprehensive dental, yearly limit | not offered | not offered | no change |
| Hearing aids, yearly limit for both ears | not offered | not offered | no change |
| Drug tier 1, preferred generic | $0 | $0 | no change |
| Drug tier 2, generic | $6 | $6 | no change |
| Drug tier 3, preferred brand | 20% of the cost | 20% of the cost | no change |
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
What will prescriptions cost?
| Tier | What the tier holds | 2026 | 2027 |
|---|---|---|---|
| Tier 1 | Preferred Generic | $0 | $0 |
| Tier 2 | Generic | $6 | $6 |
| Tier 3 | Preferred Brand | 20% of the cost | 20% of the cost |
| Tier 4 | Non-Preferred Drug | 25% of the cost | 29% of the cost |
| Tier 5 | Specialty Tier | 27% of the cost | 26% of the cost |
Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.
How does it compare with plans sold where it is?
In the counties it serves, 26 plans open to everyone are sold for 2027, this one included. Against the others, 14 plans have a lower out-of-pocket limit, 5 the same, 6 a higher one. On the premium, 19 plans have a lower premium, 6 a higher one.
Out-of-pocket limits of the 26 plans open to everyone
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
It stops serving 7 counties it served in 2026 (listed in the next section).
The premium and the out-of-pocket limit are the same in all 1 county: $49 a month and $7,150.
Oregon
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
What if you live in a county it leaves?
Its 2026 members in the 7 counties listed below cannot stay in it for 2027; each county page lists the 2027 plans sold there.
- Your coverage
- This plan ends for you on December 31, 2026, because it is no longer sold where you live.
- October 15 to December 7, 2026
- Open enrollment: join another Medicare Advantage plan, or Original Medicare with a drug plan. Coverage starts January 1, 2027.
- December 8, 2026 to the end of February 2027
- A special enrollment period because the plan is leaving: you can still join a plan, but coverage starts the first day of the month after you join, so choose by December 31 to have no gap.
- If you do nothing
- You are enrolled in Original Medicare when the plan ends, without a drug plan unless you join one (with Extra Help or full Medicaid, Medicare enrolls you in one).
- Without a drug plan
- Going 63 days or more in a row without drug coverage can mean a late enrollment penalty if you join a drug plan later; joining by the end of February keeps a January and February gap under 63 days, waiting longer does not.
- If you choose Original Medicare
- You have a guaranteed right to buy Medigap Plan A, B, C, D, F, G, K or L sold in your state by any insurance company; if you were new to Medicare on or after January 1, 2020, Plans D and G take the place of C and F. Apply from 60 days before to 63 days after the plan ends; the policy starts once your Medicare Advantage coverage ends. Other Medigap plans are not covered by this right.
| County | Members, Sept. 2026 |
|---|---|
| Deschutes, OR | 11,320 |
| Crook, OR | 1,863 |
| Jefferson, OR | 1,417 |
| Wasco, OR | 901 |
| Hood River, OR | 360 |
| Klamath, OR | 238 |
| Sherman, OR | 57 |
Source: CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11); Medicare.gov, “Special enrollment periods” and “When can I buy Medigap?” (read Oct. 7, 2026).
Who runs this plan?
- Plan ID
- H3864-036
- Legal name of the contract
- PacificSource Community Health Plans
- Sold as
- PacificSource Medicare
- Parent company
- PacificSource
- Plan type
- HMO-POS
- 2026 star rating of the contract
- 3.5 of 5 overall; health plan 3.5 of 5, drug plan 3.5 of 5
- Members, September 2026
- 21,049
- Plan website, as filed with CMS
- www.Medicare.PacificSource.com
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in Deschutes, ORWhere most of its members live; premiums and limits side by side
- Every PacificSource Medicare plan for 2027Its contracts, counties and plans that end
- The other 6 plans of contract H3864Same company, same contract
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.