PacificSource Health Plans Insurance Review & Complaints: Health Insurance (2023)

Based in Oregon, PacificSource Health Plans provides health plan options to residents of that state as well as Montana and Idaho. They offer individual as well as group plans including dental insurance.

What is PacificSource Health Plans?

Physicians at Pacific Christian Hospital in Eugene, Oregon, founded PacificSource in 1933; within two years, the growing organization adopted the name Pacific Hospital Association (PHA). Operating in Lane County, the not-for-profit insured mostly government employees and wood product companies.

In the 1980s, PHA began to expand into surrounding counties, reaching statewide by the end of the 1990s. In 1994, the company changed its name to PacificSource Health Plans. In 2007, PacificSource expanded into Idaho and acquired Clear One Health Plans in 2010 to move into Montana as well. The company is also licensed in Washington State, although they do not currently offer health plans there.

PacificSource today offers a range of health plans for individuals and families while also continuing to offer coverage through employers. They have 272,000 members across their regional coverage area. PacificSource also writes Medicare Advantage and dental plans.

What coverage does PacificSource health plans offer?

PacificSource offers a range of PPO health plan options across three states; for the purpose of this review, we will take a look at the products offered in Oregon, where the company is based.

Plans are offered with two different networks, SmartChoice or Legacy Health, depending on the county in which the insured resides. The same four plan levels are offered in each network, with a standard plan at each level as well as several underlying options that require the applicant to meet specific requirements under the ACA. These cost-sharing plans can be purchased through the state healthcare marketplace.

Catastrophic

This plan is offered in either network with a deductible of $7,350, which is also the out-of-pocket maximum each year. Preventative care is not subject to the deductible, and this plan also covers three primary care visits per year at 100% before the deductible applies. After the deductible, all care is covered in full with no additional costs.

Bronze

The standard Bronze plan has an individual deductible of $6,650, doubled for families. Outside preventative care, all services are subject to the deductible and covered in full thereafter.

At this level, there is one cost-sharing plan available that is a $0 cost option, but as noted previously, this requires the applicant to qualify under ACA regulations.

Silver

The standard Silver plan has a $2,500 individual deductible, doubled for families. Primary care visits have a $40 copay, while specialist visits have an $80 copay. Prescription drug coverage starts with a $15 copay for Tier 1, and the deductible does not apply.

The Silver plan has a variety of options available to those who meet income and other requirements under ACA regulations, including a $0 cost-sharing plan. There are a total of five cost-sharing plan options.

Gold

PacificSource’s standard Gold plan has a $1,000 deductible per person, doubled to $2,000 per family. The co-pays with this plan are $20 for a primary care visit and $40 for a specialist. Tier 1 drugs under this plan start at a $10 copay, and the deductible does not apply.

PacificSource offers two cost-sharing plans at the Gold level, both of which have income and other requirements.

Dental Plans

Dental Advantage is available as a family plan as well as for kids only. This plan is a PPO with coverage both in and out-of-network, although out-of-network costs are higher.

Some services are covered in full, while others have a coinsurance of 20% or 50%. The per-person maximum per calendar year is $1,000.

Medicare Advantage

PacificSource offers Medicare Advantage plans that vary based on region. We pulled sample plans for the Portland, Oregon area.

Both plans are HMO plans, with the MyCareRx 31 offering $5 primary care visits and $35 specialist visits. The more expensive MyCare Rx 28 plan has the same copay for primary care, but a lower $25 copay for specialists, and lower co-pays in other areas.

Both plans include Part D prescription coverage. The Rx 31 starts at $3 for Tier 1. A deductible of $250 applies to Tiers 3, 4, and 5, but not the two lower tiers. The Rx 28 starts at $2 for Tier 1 and again has a deductible of $150 applying to Tiers 3, 4, and 5.

Both plans have the option to add dental coverage for an added premium.

PacificSource Advantage plans cover at least the same healthcare services as the original Medicare plus additional benefits, including gym membership, vision and hearing exams, 24-hour nurse line, and coverage for some over-the-counter medication.

Also, if you are on a PacificSource Medicare Advantage Plan, you can call them up and order a free Fitbit or Garmin watch to track your overall health and fitness.

Are the rates reasonable?

We ran a quote for plans in the Portland, Oregon area, using a 30-year-old male who is not a tobacco user.

The rates we returned started at $320 a month for the Bronze standard plan and went up to $509 a month for the Gold standard plan. Since these are local rates from a regional insurer, we are unable to accurately compare them to rates in other locations, but the rates appear to be on the high side based on what we have seen elsewhere. This includes our quotes from other regional insurers in Oregon, such as Providence Health Plan, which charges about $100 less for its bronze plan. It should be noted that coverage and network options are not apples to apples on these two plans, making the comparison only a general one.

The Medicare Advantage rates are readily available. The Rx 31 plan is $23 per month. These rates appear to be reasonable based on what we have seen for this type of coverage elsewhere, although again, we are unable to do a direct comparison with other locations.

How are claims processed?

As with most health insurance companies, PacificSource handles billing directly with providers, although coverage that is out-of-network may occasionally result in a member needing to deal with a claim.

The website offers little in the way of claims information, and members can contact the customer service department for questions regarding claim payment.

Are the ratings and consumer reviews positive?

PacificSource Health Plans has an A+ rating with the Better Business Bureau (BBB), with only four complaints on file in the past three years. Three of those have closed in the past 12 months.

On the company’s head office Facebook page there are 54 reviews, fairly evenly split between positive and negative, with 24 5-star reviews, 21 1-star reviews, and the rest in between for an overall 3.1-star rating. The reviews are quite detailed, with several negative reviews citing refusal to pay claims for personal health services and billing issues. Positive reviews are less detailed, some with only a star rating and no comment at all. The company seems to have attracted a very strong detractor, who claims the 5-star ratings are fake – there’s no evidence to back this claim.

PacificSource ratings from the National Committee for Quality Assurance for all three states are middling to poor. In Oregon and Idaho, the company has an overall 3.0 rating, and in Montana, the rating is lower at 2.5. The company generally received mid to low scores in all areas of customer satisfaction, with a few higher ratings in some categories.

The PacificSource Customer Service team remains available during business hours, Monday through Friday, from 8:00 a.m. to 5:00 p.m. As long as COVID-19 is a concern, PacificSource remains focused on how best to serve you.

Are video visits with a Primary Care Doctor online covered by PacificSource Health Plans?

Most insurers provide coverage for video visits at the same cost as in-person visits. You can choose your own primary care provider, and you have the freedom to see specialists without a referral.

The Bottom Line

PacificSource offers a basic selection of health plans in three states, with a heavy focus on a wider selection of options for those that qualify for cost-sharing programs under the ACA. While the complaint volume isn’t alarmingly high, the detailed content of the Facebook complaints does raise some concern regarding the denial of claims. Although they might be worth comparing, most Oregon residents (and probably other states as well) who do not qualify for subsidies are likely to find lower premiums from other companies, either local or national.