Core Gold 3000
PacificSource Health Plans · 2026 plan year
Gold
- Ind. medical deductible
- $3,000
- Rx deductible (separate)
- $0
- Family deductible
- $6,000
- Ind. OOP max
- $8,000
- Family OOP max
- $16,000
This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.
Compare with other Gold plans in OR
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More PacificSource Health Plans plans in OR
Monthly premiums by age
Rating Area 1 — the lowest-priced of the 7 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $318 | $318 |
| 21 | $501 | $601 |
| 30 | $568 | $682 |
| 40 | $640 | $768 |
| 50 | $895 | $1,073 |
| 60 | $1,359 | $1,631 |
| 64 and over | $1,503 | $1,803 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $40.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $60.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 20.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 20.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 20.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $40.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $15.00 |
| Medical Service Drugs | Not covered |
| Non-Preferred Brand Drugs | 50.00% |
| Preferred Brand Drugs | $40.00 |
| Specialty Drugs | 50.00% |
| Zero Cost Share Preventive Drugs | No charge |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 20.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $40.00 |
Other
| Benefit | In-network |
|---|---|
| Hearing Aids | 20.00% |
| Home Health Care Services | 20.00% Coinsurance after deductible |
| Abortion for Which Public Funding is Prohibited | No charge |
| Accidental Dental | 20.00% Coinsurance after deductible |
| Acupuncture | $40.00 |
| Allergy Testing | 20.00% Coinsurance after deductible |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | 20.00% Coinsurance after deductible |
| Chiropractic Care | $40.00 |
| Cosmetic Surgery | 20.00% Coinsurance after deductible |
| Delivery and All Inpatient Services for Maternity Care | 20.00% Coinsurance after deductible |
| Dental Check-Up for Children | Not covered |
| Diabetes Education | $40.00 |
| Dialysis | 20.00% Coinsurance after deductible |
| Durable Medical Equipment | 20.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 20.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Gender Affirming Treatment | See plan details |
| Habilitation Services | $40.00 |
| Hormone Therapy | See plan details |
| Hospice Services | 20.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 20.00% Coinsurance after deductible |
| Infertility Treatment | Not covered |
| Infusion Therapy | 20.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 20.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 20.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Non-Preferred Generic | Not covered |
| Nutritional Counseling | $40.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $40.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 20.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | $40.00 |
| Preferred Generic | $15.00 |
| Prenatal and Postnatal Care | 20.00% Coinsurance after deductible |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 20.00% Coinsurance after deductible |
| Radiation | 20.00% Coinsurance after deductible |
| Reconstructive Surgery | 20.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $40.00 |
| Rehabilitative Speech Therapy | $40.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | No charge |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | 20.00% Coinsurance after deductible |
| Skilled Nursing Facility | 20.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 20.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $40.00 |
| Telehealth - Primary | $40.00 |
| Telehealth - Specialist | $60.00 |
| Transplant | No Charge after deductible |
| Treatment for Temporomandibular Joint Disorders | Not covered |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 20.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 1 geographic area.
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