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Regence Valiance (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence Valiance (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Regence Valiance (PPO) in 2025, please refer to our full plan details page.
Regence Valiance (PPO) is a PPO plan offered by Cambia Health Solutions, Inc. available for enrollment in 2025 to people living in Select Counties in Idaho. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Regence Valiance (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Regence Valiance (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Regence Valiance (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $45.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
Prescription drugs are not covered by Regence Valiance (PPO).
Additional Benefits
The Regence Valiance (PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay for the first few days, with no copay for the majority of the stay. Outpatient services, including primary care and specialist visits, often have copays, while preventive services and some vision and dental services have no copay. The plan covers hearing exams, hearing aids (with a copay), and offers coverage for medical equipment and home health services. Some services require coinsurance, like outpatient services and diagnostic radiology. Prescription hearing aids have a copay, and the plan also includes coverage for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for both acute and psychiatric care. For the first 5 days of an inpatient hospital stay, there is a $350 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $35 copay and 20% coinsurance, observation services with a $400 copay, ambulatory surgical center services with a $35 copay and 20% coinsurance, outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Regence Valiance (PPO) plan, with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $275 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services and Worldwide Emergency Coverage, there is a $125 copay, while Urgently Needed Services have a $30 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Regence Valiance (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $15 copay, and physician specialist services with a $35 copay. The plan also covers mental health specialty services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a $35 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services, some of which may have a copay. This plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and telemonitoring services. Home-based palliative care, fitness benefits, remote access technologies, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing services include coverage for hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $499 and $999. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services include eye exams, eyewear, and contact lenses. Eye exams and eyewear have no copay, while contact lenses are covered with a maximum benefit coverage of $100 per year.
Dental Services See details
Dental Services are covered by the Regence Valiance (PPO) plan, with a $35 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments are covered with no copay, while restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery have a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Regence Valiance (PPO) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance from 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Regence Valiance (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered. DME has a 20% coinsurance, while Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, and Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Regence Valiance (PPO) plan with no copay and no coinsurance; however, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Regence Valiance (PPO) plan. Although Cardiac Rehabilitation Services are generally covered, the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Regence Valiance (PPO) plan, but require prior authorization. You will pay a copay of $10 for days 1-20, $214 for days 21-46, and no copay for days 47-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items, with a maximum benefit of $40.00 every three months, and meal benefits for a chronic illness. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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