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Regence MedAdvantage + Rx Classic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence MedAdvantage + Rx Classic (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 Classic (PPO) in 2025, please refer to our full plan details page.
Regence MedAdvantage + Rx Classic (PPO) is a PPO plan offered by Cambia Health Solutions, Inc. available for enrollment in 2025 to people living in Select Counties in Utah. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Regence MedAdvantage + Rx Classic (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 Classic (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 Classic (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.00. 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:
Sign up for Regence MedAdvantage + Rx Classic (PPO)
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Drug Coverage
The Regence MedAdvantage + Rx Classic (PPO) plan has a $100 deductible for prescription drugs. After meeting the deductible, you'll pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $5 copay at preferred pharmacies. The plan has different costs for drugs based on the pharmacy you use, as well as the drug tier. 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 Classic (PPO) plan offers a wide range of benefits. The plan covers inpatient hospital stays with a $350 copay for the first four days, and no copay for the remainder of the stay. Outpatient services have varying copays and coinsurance, and preventive services, including an annual physical, are covered with no copay. The plan also includes coverage for hearing, vision, and dental services. Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Vision services include eye exams, routine eye exams, eyeglass lenses, and eyewear with no copay, and contact lenses and eyeglass frames with a maximum annual benefit. Dental services include oral exams, dental x-rays, and Medicare dental services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-4, and no copay for days 5-90; for Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-4, and no copay for days 5-90. Additional Days for Inpatient Hospital-Acute is covered with no copay, 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 sessions for outpatient substance abuse with a $30 copay, and outpatient blood services with no copay. Prior authorization is required for outpatient hospital services, ambulatory surgical center services, and outpatient substance abuse services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Regence MedAdvantage + Rx Classic (PPO) plan with a $105 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Regence MedAdvantage + Rx Classic (PPO) plan. 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 and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Regence MedAdvantage + Rx Classic (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $35 copay. Mental health specialty services, psychiatric services, and opioid treatment program services are covered with a copay that varies from $30-$35. Additional telehealth benefits are covered with a copay between $0 and $35. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
The Regence MedAdvantage + Rx Classic (PPO) plan covers preventive services including an annual physical exam with no copay. The plan also covers additional preventive services, kidney disease education services, and other preventive services, with some services having no copay. This plan does not cover health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, 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.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are partially covered, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. There is no copay for eye exams, routine eye exams, eyeglass lenses, and eyewear. Contact lenses are covered with a maximum benefit of $100 every year, and eyeglass frames are covered with a maximum benefit of $100 every year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Regence MedAdvantage + Rx Classic (PPO) plan covers dental services, including Medicare dental services with a $35 copay, oral exams with no copay, and dental x-rays with no copay. The plan also covers restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery with a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Regence MedAdvantage + Rx Classic (PPO) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Regence MedAdvantage + Rx Classic (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. For DME, there is a 20% coinsurance and authorization is required, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance. 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, diagnostic procedures/tests with a $5 copay, lab services with no copay, and diagnostic radiological services with a copay up to $250. Therapeutic radiological services have a 20% coinsurance and outpatient X-ray services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Regence MedAdvantage + Rx Classic (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 not in practice as the plan states that 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 services that are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will pay a $10 copay for days 1-20, a $214 copay for days 21-49, and no copay for days 50-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items, with a maximum benefit of $15 every three months, and a Meal Benefit for a chronic illness. 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.
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