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Regence MedAdvantage + Rx Enhanced (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence MedAdvantage + Rx Enhanced (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 Enhanced (PPO) in 2026, please refer to our full plan details page.
Regence MedAdvantage + Rx Enhanced (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 Enhanced (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 Enhanced (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 Enhanced (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $224.00. 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 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:
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Drug Coverage
The Regence MedAdvantage + Rx Enhanced (PPO) plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs start at a $3 copay for a one-month supply at preferred locations, or no copay for a three-month supply via preferred mail order. Higher tier medications are covered under coinsurance, with Tier 3 preferred brand drugs requiring 20% coinsurance at preferred locations and 23% at standard pharmacies. Tier 4 non-preferred drugs carry a 35% to 38% coinsurance depending on your pharmacy choice. Tier 5 specialty drugs require 30% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Regence MedAdvantage + Rx Enhanced (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits and preventive services. Inpatient hospital stays require a $315 daily copay for days one through five and no copay for days six through 90, while outpatient hospital services carry a $30 copay and 20% coinsurance. Specialist visits require a $30 copay with no coinsurance, and emergency room care is available for a $130 copay. Routine vision, hearing exams, and preventive dental care are fully covered with no copays or coinsurance, though comprehensive dental has a 50% coinsurance up to a $1,500 annual limit. Prescription hearing aids are covered with copays ranging from $499 to $999, and home health services are available with no copay or coinsurance. Diagnostic labs and radiological services are also highly affordable, featuring no copay for lab tests and diagnostic imaging.
Inpatient Hospital See details
Inpatient hospital services are covered by Regence MedAdvantage + Rx Enhanced (PPO) with no coinsurance, requiring a $315 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Regence MedAdvantage + Rx Enhanced (PPO), including outpatient hospital services for a $30 copay and 20% coinsurance, and ambulatory surgical center visits for a $30 copay and no coinsurance. Outpatient substance abuse sessions require a $20 copay with no coinsurance, observation services cost a $400 copay per stay plus coinsurance, and outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Regence MedAdvantage + Rx Enhanced (PPO) covers partial hospitalization services with a $130.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Regence MedAdvantage + Rx Enhanced (PPO) covers Medicare-covered ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Regence MedAdvantage + Rx Enhanced (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 48 hours, and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency and urgent care are also covered with a $130 copay, while worldwide emergency transportation is covered with a $300 copay, all with no coinsurance.
Primary Care See details
Regence MedAdvantage + Rx Enhanced (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, speech, and opioid treatment therapies require a $30 copay and no coinsurance. Mental health, psychiatric, and other health professional services have a $20 copay and no coinsurance, telehealth ranges from no copay to a $30 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under the Regence MedAdvantage + Rx Enhanced (PPO) plan are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered, offering home-based palliative care and memory fitness with no copay and no coinsurance, while sub-services like health education, in-home safety assessments, and nutritional benefits are not covered.
Hearing Services See details
Regence MedAdvantage + Rx Enhanced (PPO) partially covers hearing services with no deductible, offering Medicare-covered exams for a $30 copay and no coinsurance, and routine annual exams and fitting evaluations with no copay and no coinsurance. Covered prescription hearing aids (up to two per year) have no coinsurance and a $499 to $999 copay, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Regence MedAdvantage + Rx Enhanced (PPO) offers partially covered vision services with no copay, no coinsurance, and no deductible for routine eye exams, eyeglass lenses, frames, and contact lenses. 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 Enhanced (PPO) up to a $1,500 annual limit, featuring no copay and no coinsurance for preventive care, a $30 copay and no coinsurance for Medicare-covered dental, and no copay and 50% coinsurance for covered comprehensive services. Sub-services that are not covered include adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Regence MedAdvantage + Rx Enhanced (PPO) with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, insulin, and other drugs, require no coinsurance to 20% coinsurance, with insulin also having a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Regence MedAdvantage + Rx Enhanced (PPO) covers medical equipment, offering durable medical equipment and prosthetics or medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes or inserts are covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Regence MedAdvantage + Rx Enhanced (PPO) covers diagnostic and radiological services with no coinsurance for diagnostic tests and procedures, which carry a $10 copay, and no copay for lab services. Diagnostic radiological services have no copay, outpatient X-rays require a $5 copay, and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home health services are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Regence MedAdvantage + Rx Enhanced (PPO) does not cover Cardiac Rehabilitation Services, as none of the sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered under the plan.
Skilled Nursing Facility (SNF) See details
Regence MedAdvantage + Rx Enhanced (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring a $10 copay for days 1 to 20, a $218 copay for days 21 to 44, and no copay for days 45 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Regence MedAdvantage + Rx Enhanced (PPO) does not cover Other Services, including acupuncture, over-the-counter (OTC) items, and meal benefits. Since these services are not covered by the plan, there are no copays or coinsurance options available, and members must pay the full cost out of pocket.
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