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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 2026, 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 Oregon, including Clark Co, WA. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $104.00. 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 $500.00 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 features an annual drug deductible of $500. For Tier 1 preferred generic drugs, you pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also affordable, costing as little as a $5 copay for a one-month supply at preferred locations, or no copay for a three-month supply via preferred mail order. Brand-name and specialty medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brands require a 19% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 35% coinsurance. Specialty Tier 5 drugs require a 25% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Regence MedAdvantage + Rx Classic (PPO) plan provides medical coverage with no copay and no coinsurance for primary care visits, home health services, and preventive care. For inpatient hospital stays, there is a $395 daily copay for the first five days and no copay for days six through 90. Specialist visits require a $40 copay, while emergency room visits carry a $130 copay that is waived if admitted within 48 hours. Supplemental care under this plan includes routine dental, vision, and hearing exams with no copay. Dental services feature a $1,250 annual maximum benefit with a 50% coinsurance for comprehensive care, and vision benefits cover frames and contacts up to $100. Additionally, over-the-counter items are available with no copay, while durable medical equipment is covered with no copay and a 30% coinsurance.
Inpatient Hospital See details
Regence MedAdvantage + Rx Classic (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. You will pay a $395 daily copay for days 1 through 5 and no copay for days 6 through 90, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Regence MedAdvantage + Rx Classic (PPO) covers outpatient services, including outpatient hospital services for a $40 copay and 20% coinsurance, and ambulatory surgical center services for a $40 copay with no coinsurance. Outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Regence MedAdvantage + Rx Classic (PPO) covers partial hospitalization services with a $130.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services are covered by Regence MedAdvantage + Rx Classic (PPO) with a $300 copay and no coinsurance for both ground and air transportation, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Regence MedAdvantage + Rx Classic (PPO) covers emergency services with a $130 copay (waived if admitted within 48 hours) and no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent care are covered with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $300 copay and no coinsurance.
Primary Care See details
Regence MedAdvantage + Rx Classic (PPO) features primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and opioid treatment require a $40 copay and no coinsurance. Mental health and psychiatric services have a $25 copay and no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Regence MedAdvantage + Rx Classic (PPO) provides partially covered preventive services with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and glaucoma screenings. However, sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Regence MedAdvantage + Rx Classic (PPO) covers hearing services with no copay or coinsurance for annual routine exams and unlimited hearing aid fittings, while Medicare-covered exams require a $40 copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a $499 to $999 copay, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Regence MedAdvantage + Rx Classic (PPO) with no copays, no coinsurance, and no deductibles. While routine eye exams, eyeglass lenses, eyeglass frames (up to $100), and contact lenses (up to $100) are covered, other eye exam services, upgrades, and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
Regence MedAdvantage + Rx Classic (PPO) offers partially covered dental services with an annual maximum benefit of $1,250 for both in-network and out-of-network care. Preventive services like cleanings and exams are available with no copay and no coinsurance, while Medicare-covered services require a $40 copay and no coinsurance. Other covered comprehensive services have no copay and a 50% coinsurance, though adjunctive general services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Regence MedAdvantage + Rx Classic (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry up to 20% coinsurance, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Regence MedAdvantage + Rx Classic (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Regence MedAdvantage + Rx Classic (PPO) covers durable medical equipment (DME) with no copay and 30% coinsurance, and prosthetics or medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes are also covered with no copay and no coinsurance, though prior authorization is required for these services.
Diagnostic and Radiological Services See details
Regence MedAdvantage + Rx Classic (PPO) covers diagnostic and radiological services, with prior authorization required. Diagnostic tests require a $20 copay and no coinsurance, lab services have no copay and no coinsurance, outpatient X-rays require a $10 copay plus coinsurance, and diagnostic radiology copays start at $0, while therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Regence MedAdvantage + Rx Classic (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Regence MedAdvantage + Rx Classic (PPO) with no coinsurance, though only some services are covered. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Regence MedAdvantage + Rx Classic (PPO) with no coinsurance, requiring a $10 daily copay for days 1-20, a $218 daily copay for days 21-47, and no copay for days 48-100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Regence MedAdvantage + Rx Classic (PPO) partially covers Other Services, offering coverage for Over-the-Counter (OTC) items with no copay and no coinsurance, while acupuncture and meal benefits are not covered. Covered OTC items have no maximum plan benefit limit and are eligible for reimbursement, though nicotine replacement therapy is excluded.
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