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Regence MedAdvantage + Rx Classic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence MedAdvantage + Rx Classic (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 Classic (PPO) in 2025, please refer to our full plan details page.
Regence MedAdvantage + Rx Classic (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 Classic (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 Classic (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 Classic (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $92.00. 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 $200.00 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 Classic (PPO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, for a 30-day supply, you will pay a $7 copay for preferred generic drugs at a preferred pharmacy, and 22% coinsurance for standard generic drugs. You will pay nothing for Medicare Part D covered drugs after your yearly out-of-pocket drug costs reach $2000.
Additional Benefits
The Regence MedAdvantage + Rx Classic (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, with no copay after the fourth day, while outpatient services have copays and coinsurance, like a $30 copay and 10% coinsurance for outpatient hospital services. The plan also covers primary care, preventive, hearing, vision, and dental services with specific copays or no copays for routine services. Additional benefits include ambulance, emergency, and home health services, with specific copays or no copays. Diagnostic, radiological, and medical equipment services are covered, with varying cost-sharing. The plan also covers services such as home infusion, dialysis, skilled nursing, and cardiac rehabilitation, with specific cost-sharing, but does not cover some other services like acupuncture and private duty nursing.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-4 of an inpatient stay, there is a $395 copay, and for days 5-90, there is no copay; Additional Days for Inpatient Hospital-Acute is also covered with no copay.
Outpatient Services See details
Outpatient Services include Outpatient Hospital Services with a $30 copay and 10% coinsurance, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with a $30 copay and 10% 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 by the Regence MedAdvantage + Rx Classic (PPO) plan with a $105 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Regence MedAdvantage + Rx Classic (PPO) plan. Ground and Air Ambulance Services have a $275 copay with no coinsurance, while other Transportation Services are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Regence MedAdvantage + Rx Classic (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
Primary Care services include no copay for Primary Care Physician services, a $20 copay for Chiropractic Services (but not for routine care), and a $25 copay for Occupational Therapy Services. The plan also covers a $30 copay for Physician Specialist Services, a $25 copay for Individual and Group Sessions for Mental Health Specialty Services, and a $25 copay for Physical Therapy and Speech-Language Pathology Services. Additional Telehealth Benefits are covered with a copay between $0 and $25, and Opioid Treatment Program Services are covered with a $30 copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services. Additional services include Home-Based Palliative Care, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Other services such as 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, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams are covered with no copay for 1 visit every year. Fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with a copay between $499 and $999 per year for all types, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Regence MedAdvantage + Rx Classic (PPO) plan covers vision services, including routine eye exams and eyewear. Routine eye exams and eyewear each have no copay, but some eyewear options like eyeglass frames and contact lenses may have a maximum plan benefit coverage amount.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $30 copay, oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, fluoride treatment with no copay, restorative services with 50% coinsurance, endodontics with 50% coinsurance, periodontics with 50% coinsurance, prosthodontics (removable) with 50% coinsurance, and oral and maxillofacial surgery with 50% coinsurance; however, adjunctive general services, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. The plan has a maximum benefit of $1250 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Insulin has a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Regence MedAdvantage + Rx Classic (PPO) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetics 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 include coverage for all diagnostic services, diagnostic procedures and tests with a $10 copay, and lab services with no copay. Radiological services include coverage for diagnostic radiological services with a copay up to $275, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $5 copay.
Home Health Services See details
Home Health Services are covered by the Regence MedAdvantage + Rx Classic (PPO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the listed services are covered. The plan does not offer any copay or coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is a $10 copay, for days 21-46, the copay is $214, and for days 47-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Regence MedAdvantage + Rx Classic (PPO) plan does not cover acupuncture, over-the-counter items, 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 plan covers a meal benefit for a chronic illness, but does not specify any cost-sharing details.
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