Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H3864-034-000

PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) · PacificSource Medicare · Select Idaho Counties

Compact plan code: H3864034000

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

PacificSource Medicare MyCare Choice Rx 34 (HMO-POS)

H3864-034-000 Select Idaho Counties HMOPOS
Open in quick lookup
01

In-network

Inpatient hospital

Days 1–7 $425 / day
Days 8–90 $0 / day
Total of listed copays · 7 charged days $2,975
02

Emergency transport

Ambulance

Ground · in-network$300 copay
Air · in-network$300 copay

Ground ambulance: In-network: cost sharing varies by a CMS plan-defined group; Air ambulance: In-network: cost sharing varies by a CMS plan-defined group

03

Emergency services

Emergency room

$120 copay

Waived if admitted within 72 hours

04

Medical maximum

Maximum out-of-pocket

In-network$6,600
Combined in + out$8,950
05

Skilled care at home

Home health

In-networkVerify in plan documents
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$19 / month

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H3864-002-000 PacificSource Medicare Essentials Choice 2 (HMO-POS) Select Oregon Counties · HMOPOS H3864-006-000 PacificSource Medicare Essentials Rx 6 (HMO) Select Oregon Counties · HMO H3864-014-000 PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) Select Oregon Counties · HMOPOS H3864-024-000 PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) Select Idaho Counties · HMOPOS H3864-027-000 PacificSource Medicare Essentials Rx 27 (HMO) Select Oregon Counties · HMO H3864-029-000 PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) Yellowstone County · HMOPOS H3864-030-000 PacificSource Medicare MyCare Choice 30 (HMO-POS) Select Idaho, Montana, and Oregon Counties · HMOPOS H3864-036-000 PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) Select Oregon Counties · HMOPOS

About this code

What H3864-034-000 identifies

H3864-034-000 is a Contract Year 2026 Medicare plan segment code. The compact form H3864034000 refers to the same normalized contract, plan, and segment shown on this page.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.