A non-government entity
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 Oregon/Clark Co, WA. 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 $99.00. 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 $50.00 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 $9550.00 (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 $9550.00 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:
Sign up for Regence MedAdvantage + Rx Classic (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Regence MedAdvantage + Rx Classic (PPO) plan has a $50 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. The copay for preferred generic drugs is $10 at a preferred pharmacy, and 22% coinsurance for standard generic drugs at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you may be able to pay a reduced premium. Always check the plan's formulary to see if your specific drugs are covered.
Additional Benefits
The Regence MedAdvantage + Rx Classic (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance. You can expect no copay for primary care, preventive services like annual exams, routine hearing exams, and routine eye exams. The plan also provides coverage for dental services, hearing services, and vision services with maximum annual benefits for some services. This plan also offers coverage for ambulance services, emergency services, and home health services with no copay, as well as skilled nursing facility (SNF) services. Additionally, the plan includes benefits like home infusion, dialysis services, and medical equipment coverage. However, some services, such as cardiac rehabilitation, specific hearing aids, and certain dental and vision upgrades, are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $425 for days 1-4, and no copay for days 5-90. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a $30 copay and 20% coinsurance, observation services with a $400 copay, ambulatory surgical center services with a $30 copay and 20% 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 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services each have a $300 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered, with a $125 copay, and no coinsurance. Urgently needed services are covered with a $30 copay and no coinsurance, while worldwide emergency services, including worldwide emergency coverage and worldwide urgent coverage, have a $125 copay. Worldwide emergency transportation has a $300 copay.
Primary Care See details
The Regence MedAdvantage + Rx Classic (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $30 copay, physician specialist services with a $30 copay, and mental health specialty services with a $25 copay for both individual and group sessions. Additionally, it covers other health care professionals with a $20 copay, psychiatric services with a $25 copay for both individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a $0-$30 copay, and opioid treatment program services with a $30 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, while additional preventive services and Kidney Disease Education Services have a copay, and additional services like Health Education, In-Home Safety Assessment, and others are not covered. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $499 and $999, but 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 routine eye exams and eyewear. Routine eye exams and eyeglass lenses have no copay, and you are eligible for one routine eye exam per year, and one pair of eyeglass lenses per year. Contact lenses are covered with a maximum benefit of $100 per year. Eyeglass frames have a maximum benefit of $100 per year, and you are eligible for one frame per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, and other dental services with a maximum plan benefit of $1250 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments are covered with no copay, while restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with 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, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%. Other Medicare Part B drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Regence MedAdvantage + Rx Classic (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with a 20% coinsurance, prosthetics and medical supplies with a 20% coinsurance, and diabetic equipment. Diabetic supplies and diabetic therapeutic shoes/inserts have no copay. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a $5 copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $250, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Regence MedAdvantage + Rx Classic (PPO) plan. The plan does not cover any cardiac rehabilitation services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Regence MedAdvantage + Rx Classic (PPO) plan. You will pay a $10 copay for days 1-20, a $214 copay for days 21-47, and no copay for days 48-100.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items, with a maximum benefit of $20 every three months, and Meal Benefits for chronic illnesses. 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved