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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 2026, 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 3.5 out of 5 stars in 2026.
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 $46.00. 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 $495.00 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 Classic (PPO) plan features an annual drug deductible of $495. Tier 1 preferred generic drugs have no copay when filled at a preferred pharmacy or through preferred mail order, while standard pharmacies charge a $3 copay for a one-month supply. Tier 2 generic medications cost as low as a $5 copay for a one-month supply at preferred locations, with options for no copay on three-month preferred mail orders. Brand-name and specialty prescriptions under this plan are covered using coinsurance percentages instead of flat copays. Tier 3 preferred brand drugs require a 19% coinsurance at preferred pharmacies compared to 22% at standard pharmacies, while Tier 4 non-preferred drugs range from 35% to 38% coinsurance. Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Regence MedAdvantage + Rx Classic (PPO) plan offers robust medical coverage with no copay for primary care visits, telehealth services, and annual preventive physicals. For specialized care, members pay a $40 copay for specialist visits and outpatient hospital services, while inpatient hospital stays require a $350 daily copay for the first four days followed by no copay for days five through 90. Emergency care is accessible worldwide with a $130 copay, which is waived if you are admitted to the hospital within 48 hours. This plan also features strong supplemental coverage, including no copay for routine vision exams, eyeglass lenses, and preventive dental care up to a $1,250 annual limit. Routine hearing exams and home health services are available with no copay, though prescription hearing aids require a copay ranging from $499 to $999. Additionally, there is no copay or coinsurance for diabetic supplies, while durable medical equipment is covered with no copay and a 30% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Regence MedAdvantage + Rx Classic (PPO) with no coinsurance and a $350 daily copay for days 1 through 4, followed by no copay for days 5 through 90. While unlimited additional acute care days are covered at no copay, additional psychiatric days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Regence MedAdvantage + Rx Classic (PPO) covers outpatient hospital services with a $40 copay and 20% coinsurance, and ambulatory surgical center services with a $40 copay and no coinsurance. Outpatient substance abuse services require a $30 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 Classic (PPO) covers partial hospitalization services with a $130.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Regence MedAdvantage + Rx Classic (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Regence MedAdvantage + Rx Classic (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, with no coinsurance or deductibles applying to either. Worldwide emergency and urgent care are covered with a $130 copay, while worldwide emergency transportation has a $300 copay, all with no coinsurance.
Primary Care See details
Regence MedAdvantage + Rx Classic (PPO) covers primary care physician services and select telehealth benefits with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, and mental health therapies are covered with copays ranging from $20 to $40 and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Regence MedAdvantage + Rx Classic (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, and screenings for glaucoma and diabetes. This benefit is partially covered, as sub-services such as health education, counseling, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
Regence MedAdvantage + Rx Classic (PPO) offers partially covered hearing services, which include Medicare-covered exams for a $40 copay and routine exams or fittings with no copay and no coinsurance. Prescription hearing aids are covered up to two per year with no coinsurance and a copay of $499 to $999, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Regence MedAdvantage + Rx Classic (PPO), featuring no copay, no coinsurance, and no deductible for annual routine eye exams, eyeglass lenses, and up to a $100 allowance for frames or contact lenses. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Regence MedAdvantage + Rx Classic (PPO) covers Medicare dental services for a $40 copay and no coinsurance, and preventive dental services with no copay or coinsurance up to a $1,250 annual limit. Comprehensive dental services like restorative, endodontics, periodontics, removable prosthodontics, and oral surgery are covered with no copay and 50% coinsurance, while adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Regence MedAdvantage + Rx Classic (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, are covered with a 0% to 20% coinsurance, with insulin specifically featuring a $35 copay.
Dialysis Services See details
Regence MedAdvantage + Rx Classic (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Regence MedAdvantage + Rx Classic (PPO) plan, with durable medical equipment requiring no copay and a 30% coinsurance, and prosthetics or medical supplies requiring no copay and a 20% coinsurance. Diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance, though prior authorization is required and manufacturer limitations apply.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Regence MedAdvantage + Rx Classic (PPO) plan, though prior authorization is required. Diagnostic tests have a $5 copay with no coinsurance, lab and diagnostic radiological services have no copay, outpatient X-rays require a $10 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Regence MedAdvantage + Rx Classic (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Regence MedAdvantage + Rx Classic (PPO) with no coinsurance and copayments varying by service, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Regence MedAdvantage + Rx Classic (PPO) with no coinsurance and prior authorization, allowing for admission without a prior three-day hospital stay. Patients pay a daily copay of $10 for days 1 through 20, $218 for days 21 through 48, and no copay for days 49 through 100, though additional days beyond day 100 are not covered.
Other Services See details
Other Services are partially covered by Regence MedAdvantage + Rx Classic (PPO), which offers over-the-counter (OTC) items with no copay and no coinsurance, but does not cover acupuncture or meal benefits. Covered OTC items are eligible for reimbursement and claims processing, though nicotine replacement therapy is excluded.
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