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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 2025, 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/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 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 $192.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your monthly Part D premium will be reduced.
Additional Benefits
The Regence MedAdvantage + Rx Enhanced (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, with no copay after the fifth day, and outpatient services have copays and coinsurance for some services. Many services, including primary care, preventive services, and home health services, have no copay. The plan also includes coverage for hearing and vision services, with copays for hearing exams and prescription hearing aids, and no copay for eye exams. Dental services are covered with a maximum annual benefit, and many dental services have no copay. Other services like ambulance, emergency, and skilled nursing facilities are covered, with copays for some services, while other services have coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For Inpatient Hospital-Acute, there is a $315 copay for days 1-5, and no copay for days 6-90, while additional days are covered with no copay. Inpatient Hospital Psychiatric has a $315 copay for days 1-5, and no copay for days 6-90. However, Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a $25 copay and 20% coinsurance, observation services with a $400 copay, ambulatory surgical center services with a $25 copay and 20% coinsurance, individual and group outpatient substance abuse sessions with a $20 copay, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan, but prior authorization is required. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Regence MedAdvantage + Rx Enhanced (PPO) plan. Ground and air ambulance services have a $250 copay, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan. For Emergency Services and Worldwide Emergency Coverage, there is a $125 copay, while Urgently Needed Services has a $25 copay, and Worldwide Emergency Transportation has a $250 copay; there is no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a $25 copay, and Physician Specialist Services have a $25 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $20 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $25 copay. Additional Telehealth Benefits have a copay between $0 and $25.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional services including Home-Based Palliative Care, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $25 copay. Routine hearing exams have no copay, with a limit of one exam per year. Prescription hearing aids are partially covered, with a copay between $499 and $999 for all types, but not for inner ear, outer ear, and over-the-ear hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes eye exams and eyewear. Eye exams have no copay, while contact lenses, eyeglass lenses, and eyeglass frames are covered. Eyeglass frames and contact lenses have a maximum plan benefit coverage amount of $150.00 every year, and eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Regence MedAdvantage + Rx Enhanced (PPO) plan covers dental services with a maximum benefit of $1500 per year, including oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, fluoride treatment with no copay, and other preventive dental services with no copay. Restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with 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, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan, with a coinsurance between 20% and 20%. There is no copay.
Medical Equipment See details
Medical Equipment is covered by the Regence MedAdvantage + Rx Enhanced (PPO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetics/Medical Supplies and Diabetic Equipment also have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with no copay, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Radiological Services have a maximum copay of $250. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Regence MedAdvantage + Rx Enhanced (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Regence MedAdvantage + Rx Enhanced (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Regence MedAdvantage + Rx Enhanced (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, for days 21-44, there is a $214 copay, and for days 45-100, there is no copay. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
The Regence MedAdvantage + Rx Enhanced (PPO) plan does not cover acupuncture, over-the-counter items, 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. The plan does cover a meal benefit for chronic illnesses.
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