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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 Washington. This plan received an overall rating of 3 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 $214.00. 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 $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:
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Drug Coverage
The Regence MedAdvantage + Rx Enhanced (PPO) plan features a $200 annual drug deductible. For Tier 1 preferred generics, you pay no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a $3 copay for a one-month supply. Tier 2 generic drugs cost a low $4 copay for a one-month supply at preferred pharmacies, and you can get a three-month supply with no copay through preferred mail order. For higher-tier medications, costs transition to coinsurance percentages. Tier 3 preferred brand-name drugs require a 20% coinsurance at preferred pharmacies and 23% at standard pharmacies. Tier 4 non-preferred drugs carry a 35% to 38% coinsurance, while Tier 5 specialty drugs require a flat 30% coinsurance for a one-month supply regardless of your pharmacy choice.
Additional Benefits
The Regence MedAdvantage + Rx Enhanced (PPO) plan offers robust coverage for everyday health needs, featuring no copay or coinsurance for primary care visits and routine preventive services. For emergency and urgent care, members pay a flat copay of $130 and $50 respectively with no coinsurance, while inpatient hospital stays require a $390 daily copay for the first six days and no copay thereafter. Specialist visits and outpatient hospital services are also covered with affordable copays ranging from $20 to $40. This plan also includes key supplemental benefits, providing routine vision exams and eyewear with no copay or coinsurance, alongside preventive dental care at no cost up to a $1,500 annual limit. Routine hearing exams have no copay, though prescription hearing aids require a copay between $499 and $999. Durable medical equipment and dialysis services are covered with a standard 20% coinsurance and no copay.
Inpatient Hospital See details
Regence MedAdvantage + Rx Enhanced (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $390 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Regence MedAdvantage + Rx Enhanced (PPO) covers outpatient hospital services for a $40 copay and 20% coinsurance, and ambulatory surgical center services for a $40 copay with no coinsurance. Outpatient substance abuse sessions require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Regence MedAdvantage + Rx Enhanced (PPO) covers partial hospitalization services with a $130.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Regence MedAdvantage + Rx Enhanced (PPO) covers ground and air ambulance services with a $300 copay, no coinsurance, and prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Regence MedAdvantage + Rx Enhanced (PPO) with a $130 copay (waived if admitted to the hospital within 48 hours) and no coinsurance, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency and urgent services are also covered with a $130 copay, and worldwide emergency transportation is covered with a $300 copay, all featuring no coinsurance.
Primary Care See details
Primary Care benefits under the Regence MedAdvantage + Rx Enhanced (PPO) plan are partially covered, with podiatry services and other chiropractic services not covered. Covered services require no coinsurance, featuring no copay for primary care visits, a $0 to $40 copay for telehealth, and copays ranging from $20 to $40 for specialist, therapy, and mental health sessions.
Preventive Services See details
Regence MedAdvantage + Rx Enhanced (PPO) partially covers preventive services, offering annual physicals, kidney disease education, and select screenings with no copay and no coinsurance. While alternative therapies and therapeutic massages are covered with a $30 copay and no coinsurance, several supplemental services such as health education, weight management, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are covered by Regence MedAdvantage + Rx Enhanced (PPO), offering Medicare-covered exams for a $40 copay and no coinsurance, while routine hearing exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $499 to $999 and no coinsurance for up to two devices per year, 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) with no copay, no coinsurance, and no deductible for routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames. Other eye exam services, eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Regence MedAdvantage + Rx Enhanced (PPO) offers partially covered dental services with an annual limit of $1,500, featuring no copay and no coinsurance for preventive care, a $40 copay and no coinsurance for Medicare-covered dental, and no copay with 50% coinsurance for covered comprehensive services. 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, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, require no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis services are covered by Regence MedAdvantage + Rx Enhanced (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Regence MedAdvantage + Rx Enhanced (PPO) plan, with durable medical equipment and prosthetics requiring no copay and 20% coinsurance. Diabetic equipment and supplies are also covered with no copay and no coinsurance, though prior authorization is required for these services.
Diagnostic and Radiological Services See details
Regence MedAdvantage + Rx Enhanced (PPO) covers diagnostic services with no coinsurance, featuring a $10 copay for tests and no copay for lab services. Covered radiological services require a $20 copay for outpatient X-rays, a minimum 20% coinsurance for therapeutic radiology, and a $0 minimum copay for diagnostic radiology, 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
Regence MedAdvantage + Rx Enhanced (PPO) provides cardiac rehabilitation services with no coinsurance, meaning some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Regence MedAdvantage + Rx Enhanced (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20, a $218 daily copay for days 21 through 47, and no copay for days 48 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
Regence MedAdvantage + Rx Enhanced (PPO) partially covers other services, offering acupuncture with a $30.00 copay and no coinsurance for up to 12 treatments per year. Supplemental benefits such as over-the-counter (OTC) items and meal benefits are not covered under this plan.
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