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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Regence MedAdvantage + Rx Enhanced (PPO) is a PPO plan offered by Regence Bluecross Blueshield of Oregon available for the 2026 plan year 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.
Below are a few key facts and commonly-asked questions about Regence MedAdvantage + Rx Enhanced (PPO).
The cost of a Medicare Advantage Plan is made up of four main parts.
For Regence MedAdvantage + Rx Enhanced (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $214.00. 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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5400.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5400.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $9550.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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.
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
The Regence MedAdvantage + Rx Enhanced (PPO) plan features a $200 annual drug deductible before coverage begins. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service, compared to a $3.00 to $6.00 copay at standard locations. Tier 2 generic drugs carry a $3.00 to $6.00 copay at preferred pharmacies, though you can get a three-month supply with no copay through preferred mail order. Higher-tier medications are subject to coinsurance rather than set copays. Tier 3 preferred brands require a 20% coinsurance at preferred pharmacies and 23% at standard pharmacies, while Tier 4 non-preferred drugs require 35% to 38% coinsurance. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply at both preferred and standard pharmacies.
The Regence MedAdvantage + Rx Enhanced (PPO) plan offers affordable access to essential medical care, featuring no copays or coinsurance for primary care visits and preventive services. Inpatient hospital stays require a $300 daily copay for the first five days and no copay for days 6 through 90, while specialist visits and outpatient hospital services carry a $30 copay, with outpatient services also requiring a 20% coinsurance. Emergency room visits have a $130 copay, which is waived if you are admitted to the hospital within 48 hours. For supplemental care, the plan provides routine vision exams and up to $150 for eyewear with no copay, alongside preventive dental care with no copay and comprehensive dental covered with 50% coinsurance up to a $1,500 annual limit. Routine hearing exams also have no copay, though prescription hearing aids require copays ranging from $499 to $999. Home health services are covered with no copay, while skilled nursing facility stays require daily copays of $10 for days 1 through 20 and $218 for days 21 through 44 before transitioning to no copay.
Regence MedAdvantage + Rx Enhanced (PPO) covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional days for acute stays are covered with no copay.
Regence MedAdvantage + Rx Enhanced (PPO) covers outpatient hospital services with a $30 copay and 20% coinsurance, and ambulatory surgical center services with a $30 copay and no coinsurance. Outpatient substance abuse services require a $20 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial hospitalization services are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan with a $130.00 copay and no coinsurance. Prior authorization is required to access this benefit.
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. Transportation services to health-related locations are not covered under this plan.
Regence MedAdvantage + Rx Enhanced (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services have a $50 copay and no coinsurance, while worldwide emergency and urgent care carry a $130 copay and worldwide emergency transportation carries a $300 copay, all with no coinsurance.
Primary care benefits offered by Regence MedAdvantage + Rx Enhanced (PPO) include primary care visits with no copay and no coinsurance, and specialist visits, physical, occupational, and speech therapies for a $30 copay and no coinsurance. Mental health, psychiatric, and other professional services require a $20 copay and no coinsurance, telehealth ranges from no copay to a $30 copay and no coinsurance, while podiatry is not covered and chiropractic services are only partially covered, with routine and other chiropractic services not covered.
Preventive services are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan with no copay and no coinsurance for annual physicals, kidney education, and diabetes self-management. Additional preventive benefits are partially covered; home-based palliative care, memory fitness, and remote access are covered with no copay and no coinsurance, while health education, PERS, alternative therapies, nutritional benefits, in-home safety, caregiver support, and counseling are not covered.
Regence MedAdvantage + Rx Enhanced (PPO) partially covers hearing services with no deductibles and no coinsurance. Covered hearing exams feature a $30 copay for Medicare-covered visits and no copay for routine annual exams and fitting evaluations. Prescription hearing aids are covered up to two per year with copays ranging from $499 to $999, but OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision services are partially covered by Regence MedAdvantage + Rx Enhanced (PPO), featuring one routine eye exam, eyeglass lenses, and up to $150 for contact lenses or frames annually with no copay, no coinsurance, and no deductible. Other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental services are partially covered by Regence MedAdvantage + Rx Enhanced (PPO), offering up to a $1,500 annual maximum for both in-network and out-of-network care. Preventive services have no copay and no coinsurance, while covered comprehensive services have no copay and 50% coinsurance, and Medicare-covered dental has a $30 copay and no coinsurance. Uncovered services include adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Regence MedAdvantage + Rx Enhanced (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Regence MedAdvantage + Rx Enhanced (PPO) covers dialysis services with no copay and a 20% coinsurance.
Regence MedAdvantage + Rx Enhanced (PPO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, requiring prior authorization. Diabetic equipment and supplies are also covered with prior authorization, featuring no copay and no coinsurance, though diabetic supplies are limited to specified manufacturers.
Regence MedAdvantage + Rx Enhanced (PPO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance and diagnostic tests for a $10 copay and no coinsurance. Outpatient X-rays require a $5 copay plus coinsurance, diagnostic radiological services have copays starting at $0, and therapeutic radiological services incur a 20% coinsurance.
Home health services are covered by Regence MedAdvantage + Rx Enhanced (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac rehabilitation services are covered by Regence MedAdvantage + Rx Enhanced (PPO) with no coinsurance, but only some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry copayments ranging from $15 to $25.
Regence MedAdvantage + Rx Enhanced (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20, $218 for days 21 through 44, and no copay for days 45 through 100. Prior authorization is required and a prior three-day hospital stay is not needed before admission, though additional days beyond the standard 100-day Medicare limit are not covered.
Other Services are not covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage. Consequently, there are no copayments or coinsurance benefits for these services, and members are responsible for the full cost.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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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.
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