A non-government entity
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 $34.00. 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:
Sign up for Regence MedAdvantage + Rx Primary (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Regence MedAdvantage + Rx Primary (PPO) plan features an annual drug deductible of $550. For generic medications, you will pay no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail-order services, copays for these generic tiers start at just $3 to $4 for a one-month supply. For brand-name and specialty drugs, costs are determined by copays or coinsurance depending on the tier. Tier 3 preferred brand drugs carry a $15 copay at preferred pharmacies and a $20 copay at standard pharmacies for a one-month supply. Tier 4 non-preferred drugs require 27% to 32% coinsurance, while Tier 5 specialty drugs have a 25% coinsurance across all pharmacy options.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers comprehensive coverage with no copay or coinsurance for primary care visits, preventive services, and routine eye exams. For specialist visits and outpatient hospital services, members can expect a $45 copay, while inpatient hospital stays require a $450 daily copay for the first five days and no copay thereafter. Emergency care is also highly accessible worldwide with a $130 copay, which is waived if you are admitted to the hospital within 48 hours. Additional benefits include preventive dental and routine hearing exams with no copay or coinsurance, alongside a $1,000 annual allowance for comprehensive dental services. Diabetic equipment and supplies are also fully covered with no copay or coinsurance, while other durable medical equipment requires a 35% coinsurance. This plan reduces out-of-pocket stress by eliminating deductibles for key services like routine vision, helping you manage your healthcare budget effectively.
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 to 5 and no copay for days 6 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Regence MedAdvantage + Rx Primary (PPO) covers outpatient hospital services with a $45 copay and 20% coinsurance, while ambulatory surgical center and outpatient substance abuse services require a $45 copay and no coinsurance. Outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Regence MedAdvantage + Rx Primary (PPO) covers partial hospitalization services with a $130.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Regence MedAdvantage + Rx Primary (PPO) covers 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 under this plan.
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 urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent care are 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) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Physical, occupational, and speech therapy services require a $40 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Regence MedAdvantage + Rx Primary (PPO) covers preventive services, annual physical exams, and kidney disease education with no copayments and no coinsurance. Additional preventive benefits are partially covered with no copays or coinsurance for home-based palliative care, memory fitness, and remote access, while services such as health education, weight management, counseling, and in-home safety assessments are not covered.
Hearing Services See details
Regence MedAdvantage + Rx Primary (PPO) partially covers hearing services, offering Medicare-covered exams for a $45 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered with no coinsurance and a copay between $499 and $999 for up to two aids per year, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Regence MedAdvantage + Rx Primary (PPO), featuring no copay, no coinsurance, and no deductible for annual routine eye exams, eyeglass lenses, frames, and contact lenses, with a $100 annual limit for frames and contacts. Other eye exams, upgrades, and combined eyeglasses are not covered.
Dental Services See details
Dental services are partially covered by Regence MedAdvantage + Rx Primary (PPO) up to a $1,000 annual limit, featuring no copay or coinsurance for preventive care and a $45 copay with no coinsurance for Medicare-covered dental. Covered comprehensive services require no copay and a 50% coinsurance, though orthodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and adjunctive general services are not covered.
Home Infusion bundled Services See details
Regence MedAdvantage + Rx Primary (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a 0% to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by the Regence MedAdvantage + Rx Primary (PPO) plan 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 and medical supplies with no copay and a 20% coinsurance. Diabetic equipment and supplies are covered with no copay and no coinsurance from specified manufacturers, though prior authorization is required for all equipment categories.
Diagnostic and Radiological Services See details
Regence MedAdvantage + Rx Primary (PPO) covers diagnostic and radiological services, with prior authorization required. Diagnostic tests require a $40 copay and no coinsurance, lab services and diagnostic radiology have no copay or coinsurance, outpatient X-rays require a $25 copay, and therapeutic radiology requires a 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 standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation (with a $40 copay), pulmonary rehabilitation (with a $15 copay), and SET for PAD services (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Regence MedAdvantage + Rx Primary (PPO) with no coinsurance, requiring a daily copay of $10 for days 1-20, $218 for days 21-50, and no copay for days 51-100. Prior authorization is required, a prior three-day hospital stay is not mandatory, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Regence MedAdvantage + Rx Primary (PPO) does not cover Other Services, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved