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Regence BlueAdvantage HMO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence BlueAdvantage HMO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Regence BlueAdvantage HMO (HMO) in 2026, please refer to our full plan details page.
Regence BlueAdvantage HMO (HMO) is a HMO plan offered by Cambia Health Solutions, Inc. available for enrollment in 2025 to people living in Select Counties in Washington. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Regence BlueAdvantage 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 BlueAdvantage 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 BlueAdvantage HMO (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.00. 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 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 BlueAdvantage HMO (HMO) Medicare prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail order services, compared to a $3 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs carry a $4 copay for a one-month supply at preferred pharmacies, with the added benefit of no copay for a three-month supply filled via preferred mail order. Higher-tier medications are subject to coinsurance under this plan. Tier 3 preferred brand drugs require 22% coinsurance at preferred locations and 25% at standard locations, while Tier 4 non-preferred drugs carry a 40% to 43% coinsurance. Specialty Tier 5 medications require a flat 30% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Regence BlueAdvantage HMO (HMO) plan offers affordable access to everyday medical care, featuring no copay and no coinsurance for primary care visits and covered preventive services. Specialist visits require a $55 copay with no coinsurance, while emergency room visits carry a $130 copay that is waived if you are admitted. For inpatient hospital stays, you will pay daily copays for the first six days with no coinsurance, followed by no copay for days 7 through 90. Routine hearing and vision exams are covered with no copay, and the plan provides up to $100 annually for contacts or frames. Dental care is partially covered up to a $1,000 annual limit, offering preventive dental services with no copay and comprehensive services with a 50% coinsurance. However, it is important to note that this plan does not cover over-the-counter items, meal benefits, acupuncture, or routine transportation.
Inpatient Hospital See details
Regence BlueAdvantage HMO (HMO) covers inpatient hospital services with no coinsurance, charging a copay of $455 per day for days 1 through 6 for acute care and $390 per day for days 1 through 6 for psychiatric care, with no copay for days 7 through 90. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Regence BlueAdvantage HMO (HMO) covers outpatient hospital services with a $55 copay and 20% coinsurance, and ambulatory surgical center services with a $55 copay and no coinsurance. Outpatient substance abuse services require a $45 copay with no coinsurance, observation services carry a $400 copay per stay plus coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Regence BlueAdvantage HMO (HMO) covers partial hospitalization services with a $130.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Regence BlueAdvantage HMO (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, although prior authorization is required. For transportation benefits, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Regence BlueAdvantage HMO (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency and urgent services have a $130 copay and worldwide emergency transportation has a $300 copay, all with no coinsurance.
Primary Care See details
Regence BlueAdvantage HMO (HMO) features primary care doctor visits with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Other covered benefits include physical, occupational, and speech therapies for a $50 copay, mental health specialty services with copays up to $45, and telehealth options ranging from no copay to a $50 copay, all with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Regence BlueAdvantage HMO (HMO) with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, and home-based palliative care. However, several services are not covered, such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are covered by Regence BlueAdvantage HMO (HMO), offering routine exams and fitting evaluations with no copay and no coinsurance, alongside Medicare-covered exams for a $55 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $999, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Regence BlueAdvantage HMO (HMO), offering one routine eye exam, one pair of eyeglass lenses, and contact lenses or eyeglass frames (up to $100) per year with no copay, no coinsurance, and no deductible. Other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Regence BlueAdvantage HMO (HMO) offers partially covered dental services up to a $1,000 annual limit, excluding adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics. Preventive care has no copay and no coinsurance, while Medicare-covered dental services require a $55 copay and no coinsurance. Other covered comprehensive services, such as restorative and endodontics, require no copay and 50% coinsurance.
Home Infusion bundled Services See details
Regence BlueAdvantage HMO (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs require no copay and no coinsurance to 20% coinsurance, while insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Regence BlueAdvantage HMO (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Regence BlueAdvantage HMO (HMO) covers medical equipment, including durable medical equipment (DME) with no copay and 30% coinsurance, and prosthetics or medical supplies with no copay and 20% coinsurance. Diabetic equipment and supplies are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Regence BlueAdvantage HMO (HMO) with prior authorization, offering lab services and diagnostic radiological services with no copay and no coinsurance. Diagnostic procedures and outpatient X-rays require a $25 copay, while therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Regence BlueAdvantage HMO (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Regence BlueAdvantage HMO (HMO) with no coinsurance, but only some services are covered in practice. Specifically, Cardiac Rehabilitation (with a $40 copay), Intensive Cardiac Rehabilitation ($40 copay), Pulmonary Rehabilitation ($30 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Regence BlueAdvantage HMO (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20, a $218 daily copay for days 21 through 50, and no copay for days 51 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are not covered under the Regence BlueAdvantage HMO (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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