Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
PacificSource Oregon Dual Rx, 2027
H3864Contract043Plan
HMO D-SNP · special needs plan, dual-eligible · 8 counties in Oregon
Run by PacificSource Community Health Plans (contract H3864), sold as PacificSource Medicare, owned by PacificSource
PacificSource Oregon Dual Rx (H3864-043) costs $0 a month in 2027, down $10.50 from 2026, with an in-network out-of-pocket limit of $9,250. In 2026 it was called PacificSource Dual Care.
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Plan name | PacificSource Dual Care | PacificSource Oregon Dual Rx | renamed |
| Monthly premium | $10.50 | $0 | ▼down $10.50 |
| Drug deductible | $615 | $400 | ▼down $215 |
| Eyewear, yearly limit | $190 a year | $47.50 a year | ▼down $142.50 |
| Over-the-counter items, yearly | $520 a year | not offered | ▼dropped |
| Drug tier 2, generic | 25% of the cost | $0 | changed |
| Drug tier 4, non-preferred drug | 26% of the cost | 25% of the cost | ▼down 1 point |
| 15 lines do not change | |||
| In-network out-of-pocket limit | $9,250 | $9,250 | no change |
| Part B premium reduction, monthly | none | none | no change |
| Primary care visit | 20% of the cost | 20% of the cost | no change |
| Specialist visit | 20% of the cost | 20% of the cost | no change |
| Emergency room | 20% of the cost | 20% of the cost | no change |
| Medical deductible, in network | none | none | no change |
| Hospital stay, in network | not filed | not filed | no change |
| Skilled nursing facility, in network | not filed | not filed | no change |
| Ground ambulance, in network | 20% of the cost | 20% of the cost | 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 |
| Counties served | 8 | 8 | no change |
| Drug tier 1, preferred generic | $0 | $0 | no change |
| Drug tier 3, preferred brand | 25% of the cost | 25% of the cost | no change |
| Drug tier 5, specialty tier | 25% of the cost | 25% 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 | 25% of the cost | $0 |
| Tier 3 | Preferred Brand | 25% of the cost | 25% of the cost |
| Tier 4 | Non-Preferred Drug | 26% of the cost | 25% of the cost |
| Tier 5 | Specialty Tier | 25% of the cost | 25% 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, 2 dual-eligible special needs plans are sold for 2027, this one included. Against the others, 1 a higher one. On the premium, 1 the same.
Out-of-pocket limits of the 2 dual-eligible special needs plans
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?
The premium and the out-of-pocket limit are the same in all 8 counties: $0 a month and $9,250.
Oregon
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Who runs this plan?
- Plan ID
- H3864-043
- Legal name of the contract
- PacificSource Community Health Plans
- Sold as
- PacificSource Medicare
- Parent company
- PacificSource
- Plan type
- HMO D-SNP
- 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
- 4,194
- 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.