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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 $14.00. 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 will pay a copay or coinsurance for your prescriptions 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. Preferred brand drugs have a 40% coinsurance at preferred pharmacies and 43% coinsurance at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers a variety of benefits to help you manage your healthcare needs. This plan covers inpatient hospital stays with a $395 copay for days 1-5, outpatient services with copays and coinsurance, and emergency services with copays. You'll also find coverage for primary care, preventive, hearing, vision, and dental services with varying copays and coinsurance. This plan includes additional benefits like ambulance services, home health services with no copay, and medical equipment with a 20% coinsurance. It also provides coverage for services such as hearing exams, vision services, and dental services with copays and coinsurance. There is also an over-the-counter benefit and a meal benefit available.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $395 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you'll also pay a $395 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute is covered, while Non-Medicare-covered Stay and 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 $35 copay and 15% coinsurance, observation services with a $400 copay, ambulatory surgical center services with a $35 copay and 15% coinsurance, individual and group outpatient substance abuse sessions with a $35 copay, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Regence MedAdvantage + Rx Primary (PPO) plan 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 Primary (PPO) plan. Both Ground and Air Ambulance Services have a $275 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. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Regence MedAdvantage + Rx Primary (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay. The plan also covers physician specialist services with a $35 copay, mental health and psychiatric services with a $35 copay for individual or group sessions, and physical therapy and speech-language pathology services with a $40 copay. Additional telehealth benefits are available with a copay ranging from $0 to $40, and opioid treatment program services are covered with a $35 copay.
Preventive Services See details
Preventive Services include annual physical exams with no copay, as well as additional preventive services and kidney disease education services with no copay. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are also covered with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing exams have a $35 copay, and routine hearing exams have no copay for one exam per year, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $499 and $999 for two aids every year, 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, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Routine eye exams, and eyeglass lenses have no copay, while contact lenses and eyeglass frames are covered with a maximum plan benefit coverage amount. Eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments have no copay. Restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery have a 50% coinsurance. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. This plan has a $1,000 maximum plan benefit coverage amount per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Regence MedAdvantage + Rx Primary (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance and requires prior authorization, while Prosthetics/Medical Supplies and Diabetic Equipment are subject to their own cost-sharing. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a $20 copay for diagnostic procedures and tests, and no copay for lab services. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Regence MedAdvantage + Rx Primary (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 covered, but the specific services of 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. There is a copay for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Regence MedAdvantage + Rx Primary (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, for days 21-45 the copay is $214, and for days 46-100 there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and a Meal Benefit, but not Acupuncture. The OTC benefit includes a maximum of $15 every three months. The Meal Benefit is for a chronic illness. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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