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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 $134.00. 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 a $500 prescription drug deductible. For Tier 1 preferred generic drugs, you pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs cost as little as a $5 copay for a one-month supply, and you pay no copay for a three-month supply filled via preferred mail order. Brand-name and specialty medications are covered under coinsurance rates rather than flat copays. Tier 3 preferred brands require a 19% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs have a 35% coinsurance. Specialty drugs in Tier 5 carry a 25% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The Regence MedAdvantage + Rx Classic (PPO) plan offers robust coverage for everyday medical needs, including no copay and no coinsurance for primary care visits and preventive services. For urgent and emergency care, members pay a $130 copay for emergency room visits and a $50 copay for urgent care, both with no coinsurance. Inpatient hospital stays require a $425 daily copay for the first four days, followed by no copay for days five through 90. This plan also includes valuable supplemental benefits, featuring no copay and no coinsurance for routine vision exams, preventive dental care, and routine hearing tests. Comprehensive dental services are covered up to a $1,250 annual maximum with a 50% coinsurance and no copay, while over-the-counter items are also available with no copay. Additionally, home health services and diabetic equipment are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Regence MedAdvantage + Rx Classic (PPO) partially covers inpatient hospital services with no coinsurance and a $425 daily copay for days 1 through 4, followed by no copay for days 5 through 90. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Regence MedAdvantage + Rx Classic (PPO) covers outpatient hospital services with a $40 copay and 20% coinsurance, alongside ambulatory surgical center services for a $40 copay and no coinsurance. Outpatient substance abuse services require a $25 copay and no coinsurance per session, while outpatient blood services are covered with no copay or coinsurance, and observation services incur a $400 copay per stay.
Partial Hospitalization See details
Regence MedAdvantage + Rx Classic (PPO) covers partial hospitalization services with a $130.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Regence MedAdvantage + Rx Classic (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, requiring prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Regence MedAdvantage + Rx Classic (PPO) covers emergency services with a $130 copay (waived if admitted within 48 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent services are covered with a $130 copay, and worldwide emergency transportation is covered with a $300 copay, all featuring no coinsurance.
Primary Care See details
Regence MedAdvantage + Rx Classic (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and speech-language pathology require a $40 copay and no coinsurance. Mental health and psychiatric sessions have a $25 copay with no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
Regence MedAdvantage + Rx Classic (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are only partially covered, with excluded benefits including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and counseling services.
Hearing Services See details
Regence MedAdvantage + Rx Classic (PPO) hearing services cover Medicare-covered exams for a $40 copay and no coinsurance, while routine exams and hearing aid fittings have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $999 for up to two aids per year, though 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 MedAdvantage + Rx Classic (PPO) with no copay and no coinsurance for covered benefits. Routine eye exams, eyeglass lenses, eyeglass frames (up to a $100 limit), and contact lenses (up to a $100 limit) are covered annually, while other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by Regence MedAdvantage + Rx Classic (PPO) up to a $1,250 annual maximum, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive care. Covered comprehensive services require no copay and 50% coinsurance, while adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Regence MedAdvantage + Rx Classic (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and insulin drugs require a coinsurance ranging from no coinsurance up to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis services are covered by Regence MedAdvantage + Rx Classic (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Regence MedAdvantage + Rx Classic (PPO) with no copays, though prior authorization is required. Durable medical equipment carries a 30% coinsurance with no copay, prosthetics and medical supplies carry a 20% coinsurance with no copay, and diabetic equipment and supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Regence MedAdvantage + Rx Classic (PPO) covers diagnostic services with no coinsurance, offering lab services at no copay and diagnostic procedures at a $20 copay. Covered radiological services require prior authorization and range from diagnostic radiology with no copay to outpatient X-rays with a $10 copay and therapeutic radiology with 20% coinsurance.
Home Health Services See details
Home health services are covered by Regence MedAdvantage + Rx Classic (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Regence MedAdvantage + Rx Classic (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Regence MedAdvantage + Rx Classic (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 47, and no copay for days 48 to 100. Prior authorization is required, a prior 3-day inpatient hospital stay is not necessary for admission, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Regence MedAdvantage + Rx Classic (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
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