Oregon health plan · 2025

PacificSource Oregon Standard Gold Plan Navigator · 10091OR0700035

PacificSource Health Plans offers this marketplace health insurance plan (Plan ID 10091OR0700035) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: PPO CSR: Standard Gold On Exchange Plan Issuer: PacificSource Health Plans
Telehealth Data pending HSA eligible No Dental Not listed Vision Not listed
View issuer site

Issuer actuarial value: 81.01%. Expect to pay roughly 18.99% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 81.09% (18.91% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

See plan search for live pricing

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$7,000

N/A

Review MOOP rules

Office visits

Primary care See benefits
Specialist See benefits
HSA Not eligible

Drug tiers

Generic See drug coverage
Preferred brand See drug coverage

View formulary tiers

Issuer profile See benefits
Advertisement

Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Oregon). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Gold On Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 10091OR0700035
Coverage year 2025
State Oregon
Issuer PacificSource Health Plans
Marketing materials View marketing kit
Variant ID 10091OR0700035-01
Available variants

Standard On Exchange Plan · 10091OR0700035-01
Last plan update Mon, 01 Dec 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Oregon N/A
PCPs in Oregon N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers Oregon All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

4,882 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,741
SPECIALTY 1,046
NON-PREFERRED-BRAND 792
ZERO-COST-SHARE-PREVENTIVE 303
Prior authorization Drugs
Required 1,387
Not Required 3,495
Step therapy Drugs
Required 105
Not Required 4,777
Quantity limits Drugs
Has Limit 1,439
No Limit 3,443

Customer highlights

What stands out for members

  • Issuer: PacificSource Health Plans · Plan ID 10091OR0700035 · 2025 filing.
  • Disease management programs available: Pregnancy, Diabetes, Heart Disease, Asthma.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 10091OR0700035-01 (Standard On Exchange Plan) currently displayed.
Advertisement

Variant attributes

PacificSource Oregon Standard Gold Plan Navigator · Variant 10091OR0700035-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Gold On Exchange Plan

HIOS Product ID

10091OR070

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

10091OR0700035-01

Plan Marketing Name

PacificSource Oregon Standard Gold Plan Navigator

Plan Variant Marketing Name

PacificSource Oregon Standard Gold Plan Navigator

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

81.01%

Issuer ID

10091

Market Coverage

SHOP (Small Group)

Multiple In Network Tiers

No

National Network

Yes

Network ID

ORN002

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency Care Only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

In and out-of-network providers

Service Area ID

ORS003

State Code

OR

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.810889507

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

50.00%

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

20.00%

SBC Scenario, Having a Baby, Coinsurance

$2,200

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$1,500

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$700

SBC Scenario, Having Diabetes, Deductible

$900

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$100

SBC Scenario, Treatment of a Simple Fracture, Copayment

$200

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,500

Specialty Drug Maximum Coinsurance

$500

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family

per person not applicable | per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family

$7000 per person | $14000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$7,000

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family

$7500 per person | $15000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$7,500

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

ORF025

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

3

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

Yes

Drug EHB Deductible, Combined In/Out of Network, Family

per person not applicable | per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family

$0 per person | $0 per group

Drug EHB Deductible, In Network (Tier 1), Individual

$0

Drug EHB Deductible, Out of Network, Family

$5000 per person | $10000 per group

Drug EHB Deductible, Out of Network, Individual

$5,000

Dental Only Plan

No

Disease Management Programs Offered

Pregnancy, Diabetes, Heart Disease, Asthma

First Tier Utilization

100%

HSA/HRA Employer Contribution

No

Import Date

1/13/2025

HSA Eligible

No

IsItANewPlan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family

per person not applicable | per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family

$1500 per person | $3000 per group

Medical EHB Deductible, In Network (Tier 1), Individual

$1,500

Medical EHB Deductible, Out of Network, Family

$5000 per person | $10000 per group

Medical EHB Deductible, Out of Network, Individual

$5,000

Plan Effective Date

1/1/2025

Plan Expiration Date

12/31/2025

Plan Type

PPO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

10091OR0700035

Unique Plan Design

Yes

Version Number

1

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Oregon?

PacificSource Oregon Standard Gold Plan Navigator (10091OR0700035) is a Gold PPO from PacificSource Health Plans in Oregon for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does PacificSource Oregon Standard Gold Plan Navigator support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is PacificSource Oregon Standard Gold Plan Navigator HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision coverage is not listed for this plan.

Does PacificSource Oregon Standard Gold Plan Navigator support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with PacificSource Oregon Standard Gold Plan Navigator?

The issuer lists disease management resources for: Pregnancy, Diabetes, Heart Disease, Asthma.

Is there out-of-country coverage for PacificSource Oregon Standard Gold Plan Navigator?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency Care Only

Does PacificSource Oregon Standard Gold Plan Navigator cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: In and out-of-network providers

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
Issuer profile More plans
Open comparison tray

Add at least two plans to launch side-by-side comparisons.