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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 $179.00. 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. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, or "Extra Help".
Additional Benefits
The Regence MedAdvantage + Rx Enhanced (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $300 copay for the first five days, and then no copay for the rest of the stay. Outpatient services and specialist visits have copays between $20 and $25, while primary care visits have no copay. The plan also includes coverage for preventive services, hearing, vision, and dental. Preventive services, eye exams, and routine hearing exams have no copay. Dental services are covered with a $1,500 annual maximum. The plan has a $250 copay for ground ambulance and a 20% coinsurance for dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $300 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $25 copay and 15% coinsurance, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with a $25 copay and 15% coinsurance, Individual and Group Sessions for Outpatient Substance Abuse with a $20 copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $105 copay, and prior authorization is required.
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, but 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. Emergency Services have a $125 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services have a $25 copay, and Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have a $25 copay. Mental Health Specialty Services and Psychiatric Services have a copay of $20 for individual and group sessions. Additional Telehealth Benefits have a copay between $0 and $25, and Opioid Treatment Program Services have a $25 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services. Additional preventive services include coverage for Home-Based Palliative Care, Fitness Benefit, Remote Access Technologies, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a copay between $499 and $999, while OTC hearing aids, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams and eyewear, with no copay for eye exams and eyewear. Routine eye exams, eyeglass lenses, and eyeglass frames are covered with no copay, while contact lenses have a maximum benefit coverage of $150 every year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,500 annual maximum benefit for both in-network and out-of-network services. The plan covers oral exams with no copay, and provides coverage for dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay, but has limitations on the number of visits and the frequency of the services. Restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and between 0% and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Regence MedAdvantage + Rx Enhanced (PPO) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, and radiological services. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $250, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Regence MedAdvantage + Rx Enhanced (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 Enhanced (PPO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
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
Other Services are not covered, including 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 a chronic illness.
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