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Regence MedAdvantage + Rx Enhanced (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence MedAdvantage + Rx Enhanced (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 Enhanced (PPO) in 2026, please refer to our full plan details page.
Regence MedAdvantage + Rx Enhanced (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 Enhanced (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 Enhanced (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 Enhanced (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $135.00. 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 $200.00 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 Enhanced (PPO) plan features a $200 drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail-order service. For Tier 2 generic medications, costs are also highly affordable, starting at a $2 copay for a one-month supply at preferred locations and dropping to no copay for a three-month preferred mail-order supply. For higher-tier medications, costs transition to a coinsurance percentage rather than a flat copay. Tier 3 preferred brand drugs require a 20% coinsurance at preferred pharmacies compared to 23% at standard pharmacies, while Tier 4 non-preferred drugs carry a 37% or 40% coinsurance. Specialty medications in Tier 5 are covered with a flat 30% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Regence MedAdvantage + Rx Enhanced (PPO) plan provides comprehensive medical coverage, including no copay for primary care doctor visits and covered preventive services. Specialist visits require a $30 copay, while inpatient hospital stays incur a $310 daily copay for the first five days and no copay for days six through ninety. Emergency care is accessible with a $130 copay, and urgent care visits require a $45 copay. Routine dental, vision, and hearing services are also covered, featuring no copay for routine eye and hearing exams, alongside preventive dental care up to a $1,500 annual limit. Additionally, home health services and diabetic supplies are fully covered with no copay, while durable medical equipment and dialysis services require a 20% coinsurance. However, this plan does not cover acupuncture, over-the-counter items, meals, or transportation services.
Inpatient Hospital See details
Regence MedAdvantage + Rx Enhanced (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $310 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered at no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Regence MedAdvantage + Rx Enhanced (PPO) covers outpatient hospital services with a $30 copay and 20% coinsurance, and observation services with a $400 copay per stay. Ambulatory surgical center services require a $30 copay with no coinsurance, outpatient substance abuse sessions have a $25 copay with no coinsurance, and outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by Regence MedAdvantage + Rx Enhanced (PPO) with a $130.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Regence MedAdvantage + Rx Enhanced (PPO), with ground and air ambulance services requiring prior authorization and a $300 copay with no coinsurance. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Regence MedAdvantage + Rx Enhanced (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $45 copay and no coinsurance, while worldwide emergency and urgent care are covered with a $130 copay (and $300 for emergency transportation) and no coinsurance.
Primary Care See details
Regence MedAdvantage + Rx Enhanced (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Therapy, mental health, and telehealth services are also covered with copays ranging from $0 to $30 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Regence MedAdvantage + Rx Enhanced (PPO) partially covers preventive services with no copay and no coinsurance for covered services such as annual exams, kidney disease education, and home-based palliative care. However, sub-services like health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Regence MedAdvantage + Rx Enhanced (PPO) offers partially covered hearing services with no coinsurance. Medicare-covered exams require a $30 copay, routine exams and fitting evaluations have no copay, and up to two prescription hearing aids are covered yearly with a $499 to $999 copay, 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 Enhanced (PPO), offering one routine eye exam per year and select eyewear with no copay and no coinsurance. While contact lenses, eyeglass lenses, and frames are covered (up to a $150 limit for frames and contacts), other eye exam services, upgrades, and complete eyeglasses are not covered.
Dental Services See details
Dental services are partially covered by Regence MedAdvantage + Rx Enhanced (PPO) up to a $1,500 annual limit, offering preventive care with no copay and no coinsurance, and Medicare-covered dental with a $30 copay and no coinsurance. Covered comprehensive services require no copay and 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 Enhanced (PPO) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance and no copay. Covered Part B insulin has a $35 copay and no coinsurance to 20% coinsurance, with prior authorization and step therapy required for certain services.
Dialysis Services See details
Dialysis services are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan, featuring no copay and a 20% coinsurance for durable medical equipment and prosthetics. Diabetic supplies and therapeutic shoes are also covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Regence MedAdvantage + Rx Enhanced (PPO), featuring no copay and no coinsurance for diagnostic tests, lab services, and diagnostic radiological services. Outpatient X-rays require no copay but are subject to coinsurance, while therapeutic radiological services require both a copay and a 20% coinsurance, with prior authorization required for all services.
Home Health Services See details
Home health services are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Regence MedAdvantage + Rx Enhanced (PPO) with no coinsurance, but only some services are covered. Standard cardiac rehabilitation (with a $20 copay), intensive cardiac rehabilitation (with a $20 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
Regence MedAdvantage + Rx Enhanced (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 43, and no copay for days 44 to 100, while additional days beyond the 100-day limit are not covered.
Other Services See details
Regence MedAdvantage + Rx Enhanced (PPO) does not cover Other Services in practice, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage under this plan.
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