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Regence Blue MedAdvantage HMO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence Blue MedAdvantage HMO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Regence Blue MedAdvantage HMO (HMO) in 2025, please refer to our full plan details page.
Regence Blue MedAdvantage HMO (HMO) is a HMO plan offered by Cambia Health Solutions, Inc. available for enrollment in 2025 to people living in Ada and Canyon Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Regence Blue MedAdvantage HMO (HMO) 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 Blue MedAdvantage HMO (HMO).
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 Blue MedAdvantage HMO (HMO), 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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6700.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Blue MedAdvantage HMO (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you may pay an $11 copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your premium may be reduced, but you'll still pay $0.00.
Additional Benefits
The Regence Blue MedAdvantage HMO (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services. This plan includes no copay for primary care, preventive services, and routine hearing exams, and offers vision and dental benefits. The plan also covers emergency and ambulance services, and provides access to a range of specialized services like home health, skilled nursing, and home infusion. You'll have copays for services like specialist visits, hearing exams, and prescription hearing aids.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered under the Regence Blue MedAdvantage HMO plan. For Inpatient Hospital-Acute, you'll pay a $415 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. Inpatient Hospital Psychiatric services have the same cost-sharing as Inpatient Hospital-Acute. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient Hospital Services have a $35 copay and 20% coinsurance, while Observation Services have a $400 copay. Ambulatory Surgical Center (ASC) Services have a $35 copay and 20% coinsurance. Outpatient Substance Abuse Services include Individual and Group Sessions, each with a $20 copay. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Regence Blue MedAdvantage HMO (HMO) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $300 copay for both ground and air ambulance services and 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 by the Regence Blue MedAdvantage HMO (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Transportation has a $300 copay; all other services have no copay or coinsurance.
Primary Care See details
The "Regence Blue MedAdvantage HMO (HMO)" plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and occupational therapy services have a $30 copay. Physician specialist services have a $35 copay, and physical therapy and speech-language pathology services have a $30 copay. Individual and group sessions for mental health and psychiatric services have a copay between $0 and $20. Other health care professionals have a $20 copay, and opioid treatment program services have a $35 copay. Additional telehealth benefits have a copay between $0 and $30. Podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and the plan also covers additional preventive services. Additional services include Medicare-covered glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a Welcome Visit, all with no copay. Other services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $35 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) have a copay between $499 and $999, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams, eyewear, and upgrades. Eye exams and eyewear have no copay, and eyeglasses (lenses and frames) and upgrades are not covered. Contact lenses, eyeglass lenses, and eyeglass frames are covered, with a maximum benefit of $100 per year for both contact lenses and eyeglass frames.
Dental Services See details
Dental Services include a $35 copay for Medicare Dental Services, with no copay for Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services. 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, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Regence Blue MedAdvantage HMO (HMO) plan, with a coinsurance of 20%.
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 requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and Diabetic Equipment has a copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $20 copay, Lab Services with no copay, Diagnostic Radiological Services with a maximum copay of $350, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $20 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Regence Blue MedAdvantage HMO (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Regence Blue MedAdvantage HMO (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is a $10 copay, for days 21-42, the copay is $214, and there is no copay for days 43-100.
Other Services See details
The Regence Blue MedAdvantage HMO (HMO) plan's other services include coverage for Over-the-Counter (OTC) items with a maximum benefit of $15.00 every three months, and a meal benefit. 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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