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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 2025, 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 2025.
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 $181.00. 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 has a $200 deductible for prescription drugs. After you meet your deductible, your cost will vary depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $8 copay for preferred generic drugs at a preferred pharmacy, or 22% coinsurance for standard generic drugs at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your covered drugs.
Additional Benefits
The Regence MedAdvantage + Rx Enhanced (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for primary care, routine hearing and eye exams, and several dental services. It also covers inpatient hospital stays with a $350 copay for days 1-5, and no copay for days 6-90, and offers a $125 copay for emergency services. Additional benefits include coverage for outpatient services, ambulance services, and various therapies, each with specific copays or coinsurance. The plan also covers preventive services with no copay, hearing aids with a copay, and vision services including eyewear. This plan also has a $35 copay for outpatient services and a $250 copay for ground and air ambulance services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For Inpatient Hospital-Acute, there is a $350 copay for days 1-5, and no copay for days 6-90, while for Inpatient Hospital Psychiatric, there is a $350 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. 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 20% coinsurance, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with a $35 copay and 20% coinsurance, Individual and Group Sessions for Outpatient Substance Abuse each with a $30 copay, and Outpatient Blood Services with no copay. This plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered with a $105 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Regence MedAdvantage + Rx Enhanced (PPO) plan. Ground and Air Ambulance Services have a $250 copay, with no coinsurance, while 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 by the Regence MedAdvantage + Rx Enhanced (PPO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a $35 copay, while Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation. There is no coinsurance for any of these services.
Primary Care See details
The Regence MedAdvantage + Rx Enhanced (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 have a copay of $30-$35. Additional Telehealth Benefits have a copay that ranges from $0-$35, and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services including Alternative Therapies, Therapeutic Massage, and Home-Based Palliative Care. Alternative Therapies and Therapeutic Massage have a $30 copay, and Home-Based Palliative Care has no copay. Other services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $35 copay, and routine hearing exams have no copay. Fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $499 and $999. Prescription hearing aids (inner ear, outer ear, and over the ear) and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Routine eye exams and eyewear have no copay, and contact lenses are covered with a maximum benefit coverage amount of $150 every year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, and fluoride treatment with no copay, all with limitations on the number of visits. Restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with 50% coinsurance. Other services like maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance; prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered under the Regence MedAdvantage + Rx Enhanced (PPO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a $10 copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Regence MedAdvantage + Rx Enhanced (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 by the Regence MedAdvantage + Rx Enhanced (PPO) plan, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. The plan has a copay for these services, but since the services aren't covered, you will not pay anything.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Regence MedAdvantage + Rx Enhanced (PPO) plan, but prior authorization is required. For days 1-20, there is a $10 copay, for days 21-46 the copay is $214, and for days 47-100 there is no copay.
Other Services See details
Other Services includes coverage for acupuncture with a $30 copay per visit, up to 12 treatments per year, and a meal benefit for chronic illnesses. Over-the-counter items, 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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