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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 2026, 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, 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 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 $59.00. 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 $550.00 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 $10100.00 (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 $10100.00 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) Medicare plan features an annual drug deductible of $550. For prescription drugs, beneficiaries enjoy no copay on Tier 1 preferred generics and Tier 2 generics when using preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail-order services, Tier 1 drugs carry a $3 to $9 copay, while Tier 2 drugs cost between $4 and $12 depending on the supply. Tier 3 preferred brand-name drugs require a copay starting at $15 at preferred locations and $20 at standard locations for a one-month supply. For higher-tier prescriptions, Tier 4 non-preferred drugs incur a 27% coinsurance at preferred pharmacies and 32% coinsurance at standard pharmacies. Specialty drugs in Tier 5 are subject to a flat 25% coinsurance across all pharmacy and mail-order options for a one-month supply.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers robust coverage for essential medical services, featuring no copay or coinsurance for primary care visits and covered preventive services. For specialized care, members pay a $45 copay for specialist visits and physical therapy, while inpatient hospital stays require a $450 daily copay for the first five days and no copay for days 6 through 90. Emergency room visits carry a $130 copay, which is waived if admitted to the hospital within 48 hours. This plan also includes valuable supplemental benefits, such as routine vision exams and preventive dental care with no copay or coinsurance, supported by a $1,000 annual maximum for combined dental services. Routine hearing exams also have no copay, though prescription hearing aids require a copay ranging from $499 to $999. It is important to note that certain services, including routine chiropractic, podiatry, transportation, acupuncture, and over-the-counter items, are not covered under this plan.
Inpatient Hospital See details
Regence MedAdvantage + Rx Primary (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $450 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and some services—such as upgrades, non-Medicare-covered stays, and additional psychiatric days—are not covered.
Outpatient Services See details
Regence MedAdvantage + Rx Primary (PPO) covers outpatient services, including outpatient hospital care for a $45 copay and 20% coinsurance, and ambulatory surgical center services for a $45 copay with no coinsurance. Outpatient substance abuse services require a $30 copay with no coinsurance, while outpatient blood services are provided with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Regence MedAdvantage + Rx Primary (PPO) with a $130.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Regence MedAdvantage + Rx Primary (PPO) partially covers ambulance and transportation services, providing Medicare-covered ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Regence MedAdvantage + Rx Primary (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 48 hours, and urgent care with a $50 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered with a $130 copay, while worldwide emergency transportation has a $300 copay, with no coinsurance required for these services.
Primary Care See details
Regence MedAdvantage + Rx Primary (PPO) covers primary care physician services with no copay and no coinsurance, while specialists, physical therapy, and occupational therapy require a $45 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance (routine chiropractic care is not covered), whereas podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Regence MedAdvantage + Rx Primary (PPO) with no copay and no coinsurance for covered benefits such as annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies.
Hearing Services See details
Regence MedAdvantage + Rx Primary (PPO) provides partially covered hearing services with no deductibles or coinsurance, including Medicare-covered exams for a $45 copay and routine exams and fitting evaluations with no copay. Up to two prescription hearing aids are covered per year with a $499 to $999 copay and no coinsurance, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Regence MedAdvantage + Rx Primary (PPO) with no copay and no coinsurance for annual 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 Primary (PPO), featuring a $1,000 annual maximum benefit for combined in- and out-of-network care. Preventive services are available with no copay and no coinsurance, Medicare-covered dental has a $45 copay and no coinsurance, and covered comprehensive services require no copay and 50% coinsurance. Adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Regence MedAdvantage + Rx Primary (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs carry no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Regence MedAdvantage + Rx Primary (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Regence MedAdvantage + Rx Primary (PPO) covers durable medical equipment with no copay and a 35% coinsurance, and prosthetics or medical supplies with no copay and a 20% coinsurance. Diabetic equipment and supplies are covered with no copay and no coinsurance, though select manufacturer limitations and prior authorization requirements apply.
Diagnostic and Radiological Services See details
Regence MedAdvantage + Rx Primary (PPO) covers diagnostic and radiological services, with prior authorization required. Lab services and diagnostic radiological services have no copay and no coinsurance, while diagnostic tests require a $40 copay with no coinsurance, outpatient x-rays require a $25 copay with coinsurance, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Regence MedAdvantage + Rx Primary (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Regence MedAdvantage + Rx Primary (PPO) covers some cardiac rehabilitation services with no coinsurance, but in practice, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Regence MedAdvantage + Rx Primary (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring a $10 daily copay for days 1 through 20, a $218 daily copay for days 21 through 50, and no copay for days 51 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Regence MedAdvantage + Rx Primary (PPO) does not cover other services, meaning acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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