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Regence MedAdvantage + Rx Primary (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence MedAdvantage + Rx Primary (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Regence MedAdvantage + Rx Primary (PPO) in 2025, please refer to our full plan details page.
Regence MedAdvantage + Rx Primary (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 MedAdvantage + Rx Primary (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Regence MedAdvantage + Rx Primary (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 MedAdvantage + Rx Primary (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $11.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $225.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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:
Sign up for Regence MedAdvantage + Rx Primary (PPO)
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Drug Coverage
The Regence MedAdvantage + Rx Primary (PPO) plan has a $225 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $7 copay at preferred pharmacies and a $13 copay at standard pharmacies. For standard generic drugs, you'll pay 22% coinsurance at preferred pharmacies and 25% coinsurance at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay, with some days covered at no cost. Outpatient services and emergency care are covered with copays and coinsurance. Primary care visits are available with no copay, and there are copays for specialist and therapy visits. The plan also includes benefits for hearing, vision, and dental services, each with specific copays or coinsurance, and limits on what is covered. Additionally, the plan provides coverage for home health, skilled nursing, and some medical equipment.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days, and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $45 copay and 10% coinsurance, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with a $45 copay and 10% coinsurance, Individual and Group Sessions for Outpatient Substance Abuse with a $30 copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Regence MedAdvantage + Rx Primary (PPO) plan with a $105 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Regence MedAdvantage + Rx Primary (PPO) plan. Ground and Air Ambulance Services have a $350 copay, with no coinsurance, while 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, and for Urgently Needed Services, there is a $55 copay, and for Worldwide Emergency Transportation, there is a $350 copay. Worldwide Urgent Coverage also has a $125 copay. There is no coinsurance for any of these services.
Primary Care See details
Primary Care services with the Regence MedAdvantage + Rx Primary (PPO) plan include no copay for Primary Care Physician services, a $20 copay for Chiropractic Services, a $30 copay for Occupational Therapy Services, and a $45 copay for Physician Specialist Services. Additionally, Individual and Group Sessions for Mental Health and Psychiatric Services have a $30 copay, Physical Therapy and Speech-Language Pathology Services have a $30 copay, Additional Telehealth Benefits have a $0-$40 copay, and Opioid Treatment Program Services have a $45 copay. Routine Chiropractic Care and Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services, kidney disease education services, and other preventive services. Home-Based Palliative Care, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit all have no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay. Routine hearing exams have no copay, and you are allowed 1 exam every year. Fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. Prescription hearing aids (all types) have a copay between $499 and $999. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Routine eye exams and eyeglass lenses have no copay, while contact lenses and eyeglass frames are limited to one pair per year with a maximum benefit of $100. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include a $45 copay for Medicare dental services, no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments. Restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery have a 50% coinsurance. Adjunctive general services, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Regence MedAdvantage + Rx Primary (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and prior authorization required. Prosthetics/Medical Supplies have no copay, with a 20% coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is covered with no copay for diabetic supplies and therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $15 copay, Lab Services with no copay, and Diagnostic Radiological Services with a copay of at most $300.00. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by Regence MedAdvantage + Rx Primary (PPO) with no copay and no coinsurance. 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 MedAdvantage + Rx Primary (PPO) plan. 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 by the Regence MedAdvantage + Rx Primary (PPO) plan. For days 1-20, there is a $10 copay, for days 21-37, there is a $214 copay, and for days 38-100, there is no copay.
Other Services See details
The "Regence MedAdvantage + Rx Primary (PPO)" plan does not cover 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. This plan offers an Over-the-Counter (OTC) Items benefit with a maximum of $15 every three months, and a Meal Benefit for chronic illnesses.
Get Personalized Help from a licensed insurance agent
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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