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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 $22.00. 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:
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Drug Coverage
The Regence MedAdvantage + Rx Primary (PPO) plan has a $225.00 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $7.00 copay for preferred generic drugs at a preferred pharmacy, or 22% coinsurance for standard generic drugs at a preferred pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with copays and coinsurance, and emergency services. Primary care, preventive, hearing, vision, and dental services are also included, with varying copays and coverage limits for specific services like hearing aids and dental work. This plan provides coverage for home health services, medical equipment, and diagnostic services with a mix of copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered under this plan. For Inpatient Hospital-Acute, you will pay a $405 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will also pay a $405 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a $35 copay and 10% coinsurance, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with a $35 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 under the Regence MedAdvantage + Rx Primary (PPO) plan, but requires prior authorization. You will have a $105 copay for this benefit.
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 $275 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 under the Regence MedAdvantage + Rx Primary (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Transportation has a $275 copay; all have no coinsurance.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services (routine care not covered), a $30 copay for Occupational Therapy, a $35 copay for Physician Specialist Services, and a $30 copay for Individual and Group Sessions for Mental Health and Psychiatric Services. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Other Health Care Professional services have a $20 copay. Additional Telehealth Benefits have a copay between $0 and $30, and Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services with a copay. Other services like health education and counseling services are not covered.
Hearing Services See details
Hearing exams have a $35 copay, and routine hearing exams have no copay; fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $499 and $999. Prescription hearing aids for 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 and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Contact lenses are covered with a maximum benefit of $100 per year, and eyeglass lenses and frames are covered, with eyeglass frames covered up to $100 per year.
Dental Services See details
The Regence MedAdvantage + Rx Primary (PPO) plan covers dental services, including a $35 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), and fluoride treatments have no copay. Restorative services, endodontics, periodontics, prosthodontics (removable), and oral/maxillofacial surgery are covered with a 50% coinsurance, while adjunctive general services, maxillofacial prosthetics, implants, prosthodontics (fixed), and orthodontics are not covered. There is a $1,000 annual maximum benefit for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance 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, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance and requires authorization. Prosthetics/Medical Supplies and Diabetic Equipment have no copay, but Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Equipment requires prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a $20 copay, lab services with no copay, diagnostic radiological services with a copay up to $300, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $10 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Regence MedAdvantage + Rx Primary (PPO) plan 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 covered, but the plan does not cover any specific services. There is a copay for the covered services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Regence MedAdvantage + Rx Primary (PPO) plan, but require prior authorization. For days 1-20, the copay is $10 per day, for days 21-49 the copay is $214 per day, and for days 50-100, there is no copay. Additional days beyond Medicare coverage and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services with the Regence MedAdvantage + Rx Primary (PPO) plan includes coverage for Over-the-Counter (OTC) Items and Meal Benefits, but 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. The OTC benefit provides a maximum of $15 every three months, and the plan covers Naloxone.
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