Important details and dates

• You must be enrolled in both Medicare Part A and Medicare Part B and live in the plan's service area to be eligible for these plans.
• You are first eligible during the 7–month Initial Coverage Enrollment Period (ICEP), the 3 months before your 65th birthday, the month of, and 3 months after. CAUTION: You only have one choice so take your time, ask for help and choose wisely.
• You are also eligible during the Annual Election Period (AEP) which is from Oct.15 to Dec.7. You can change as many times as you want. The last change received by CMS prevails.
• You have an opportunity to disenroll from your plan and return to Original Medicare and purchase a Part D Prescription Drug Plan during the new Annual Disenrollment Period from Jan 1 to Feb 14.
• You must continue to pay your Medicare Part B premium in addition to any plan premium shown above.
• You may be eligible for a Special Enrollment Period (SEP) if you reside in a nursing home, join a Special Needs Plan (SNP), move outside the plan's service area, the plan leaves your area, or other special situations.

• PacificSource Community Solutions Inc., is a health plan with a Medicare contract.
• The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
• Limitations, copayments, and restrictions may apply.
• Benefits, formulary, pharmacy network, premium, and copayments/coinsurance may change on January 1 of each year.