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Regence MedAdvantage + Rx Primary (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence MedAdvantage + Rx Primary (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 Primary (PPO) in 2025, please refer to our full plan details page.
Regence MedAdvantage + Rx Primary (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 Primary (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 Primary (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 Primary (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 $100.00 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 Primary (PPO) plan has a $100 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, preferred generic drugs have a $2 copay at preferred pharmacies and a $6 copay at standard pharmacies. The plan then moves into the catastrophic coverage phase, where you pay nothing for Part D covered drugs after your yearly out-of-pocket costs reach $2000.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a $410 copay for the first five days, and outpatient services with copays ranging from $0 to $40. This plan also includes coverage for hearing and vision services, with routine eye exams and eyewear covered, along with hearing exams and hearing aids with varying copays. Dental services are covered with a $40 copay for Medicare dental services and a $1,000 maximum benefit for other dental services. Additional benefits include ambulance services with a $300 copay, emergency services with a $125 copay, and a wide array of preventive services with no copay for many services. The plan covers home health services with no copay, and skilled nursing facility services with varying copays based on the length of stay. This plan also includes coverage for home infusion, dialysis services, medical equipment, and diagnostic and radiological services, all with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered under the Regence MedAdvantage + Rx Primary (PPO) plan, but require prior authorization. For acute care, you'll pay a $410 copay for days 1-5, and no copay for days 6-90; for psychiatric care, you'll also pay a $410 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 stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $40 copay and 20% coinsurance, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with a $40 copay and 20% coinsurance, Individual and Group Sessions for Outpatient Substance Abuse with a $30 copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Regence MedAdvantage + Rx Primary (PPO) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Regence MedAdvantage + Rx Primary (PPO) plan. Ground and Air Ambulance Services have a $300 copay, with 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 by the Regence MedAdvantage + Rx Primary (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $45 copay; all have no coinsurance. Worldwide Emergency Transportation has a $300 copay, and Worldwide Urgent Coverage has a $125 copay.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services and a $20 copay for Chiropractic Services. Occupational Therapy Services have a $40 copay, and Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have a $40 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a minimum copay of $30 and a maximum copay of $30 or $40. Additional Telehealth Benefits have a copay between $0 and $40. Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional preventive services may have a copay. This plan also covers Home-Based Palliative Care, Fitness Benefits, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit 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, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $40 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, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and you are covered for one routine eye exam every year. Eyewear is covered, and includes contact lenses, eyeglass lenses, and eyeglass frames, but not eyeglasses (lenses and frames) or upgrades. Contact lenses and eyeglass frames have a maximum plan benefit coverage amount of $100 every year, and eyeglass lenses have no copay.
Dental Services See details
Dental services include a $40 copay for Medicare dental services, while other dental services have a $1,000 maximum benefit per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments have no copay, but have limits on the number of visits and periodicity. 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, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Other Medicare Part B Drugs and Chemotherapy/Radiation Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Regence MedAdvantage + Rx Primary (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and prior authorization required, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Regence MedAdvantage + Rx Primary (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a $35 copay, lab services with no copay, and outpatient X-ray services with a $20 copay. Therapeutic radiological services have a 20% coinsurance, and diagnostic radiological services have a copay of at most $300.00.
Home Health Services See details
Home Health Services are covered 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 covered, but the plan does not cover any of the sub-services. There is a copay for the services, but the amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, the copay is $10, for days 21-49, the copay is $214, and for days 50-100, there is no copay.
Other Services See details
Other Services are partially covered under the Regence MedAdvantage + Rx Primary (PPO) plan. 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. The plan covers Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $15 every three months. It also covers Meal Benefits for chronic illnesses.
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