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 $79.00. 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 prescription drug deductible of $550. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when using preferred pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail-order services, these generic drugs incur a low copay of $3 or $4 for a one-month supply. For Tier 3 preferred brand drugs, one-month copays start at $15 at preferred locations and increase to $20 at standard pharmacies. Higher-tier prescriptions, such as Tier 4 non-preferred drugs and Tier 5 specialty drugs, require coinsurance payments ranging from 25% to 32% depending on the drug tier and your pharmacy choice. This structured plan allows you to minimize your out-of-pocket prescription drug costs by utilizing preferred network pharmacies and mail-order options.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers robust coverage for essential medical services, featuring no copays or coinsurance for primary care visits and preventive screenings. For specialist visits, physical therapy, and outpatient hospital services, members typically pay a $45 copay, while emergency room visits require a $130 copay. Inpatient hospital stays require a $450 daily copay for the first five days, followed by no copay for days six through ninety. This plan also includes supplemental benefits, such as routine vision exams and preventive dental care with no copay, up to a $1,000 annual dental limit. Routine hearing exams are also covered with no copay, though prescription hearing aids require a copay ranging from $499 to $999. Additionally, members benefit from no copays on home health services and diabetic equipment, while durable medical equipment requires a 40% coinsurance.
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. Additional days for acute care are unlimited with no copay, though psychiatric additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Regence MedAdvantage + Rx Primary (PPO) covers outpatient hospital services with a $45 copay and 20% coinsurance, and ambulatory surgical center services with a $45 copay and no coinsurance. Outpatient substance abuse services require a $35 copay and no coinsurance, while outpatient blood services are 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 ground and air ambulance services with a $300 copay and no coinsurance, with prior authorization required. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Regence MedAdvantage + Rx Primary (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency and urgent services require a $130 copay, and worldwide emergency transportation has a $300 copay, all with no coinsurance.
Primary Care See details
Regence MedAdvantage + Rx Primary (PPO) primary care benefits offer primary care physician services with no copay and no coinsurance, while specialist, occupational, and physical therapy visits require a $45 copay and no coinsurance. Mental health and psychiatric sessions have a $35 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Regence MedAdvantage + Rx Primary (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, and Medicare-covered screenings. Additional preventive benefits are partially covered, offering home-based palliative care, memory fitness, and remote access technologies with no copay or coinsurance, while excluding health education, weight management, counseling, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Regence MedAdvantage + Rx Primary (PPO) partially covers hearing services, featuring a $45 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for one annual routine exam and unlimited fitting evaluations. 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, or over-the-ear prescription models are not covered.
Vision Services See details
Regence MedAdvantage + Rx Primary (PPO) provides partially covered vision services with no copay and no coinsurance for covered benefits like routine eye exams, eyeglass lenses, frames, and contact lenses. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered by the plan.
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 and no coinsurance for preventive care, and a $45 copay with no coinsurance for Medicare-covered dental. Covered comprehensive services like restorative care and endodontics require no copay and a 50% coinsurance, while adjunctive general services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Regence MedAdvantage + Rx Primary (PPO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and insulin, are subject to a 0% to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Regence MedAdvantage + Rx Primary (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Regence MedAdvantage + Rx Primary (PPO) covers medical equipment with prior authorization required and no copays across all categories. Durable medical equipment requires a 40% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment is covered with no coinsurance, though diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Regence MedAdvantage + Rx Primary (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic procedures and tests carry a $40 copay with no coinsurance, lab services and diagnostic radiological services have no copay and no coinsurance, while outpatient X-rays require a $25 copay and coinsurance, and therapeutic radiological services have a minimum 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
Cardiac rehabilitation services under the Regence MedAdvantage + Rx Primary (PPO) plan feature no coinsurance, meaning some services are covered, but specific programs like standard cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Regence MedAdvantage + Rx Primary (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20, $218 for days 21 through 49, and no copay for days 50 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are offered by Regence MedAdvantage + Rx Primary (PPO) where some services are covered, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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