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Regence MedAdvantage + Rx Primary (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence MedAdvantage + Rx Primary (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 Primary (PPO) in 2025, please refer to our full plan details page.
Regence MedAdvantage + Rx Primary (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 Primary (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 Primary (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 Primary (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $61.00. 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 $300.00 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 Primary (PPO) plan has a $300 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay a $10 copay at a preferred pharmacy, and for standard generic drugs, you'll pay 22% coinsurance at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay of $415 for days 1-5 and no copay for days 6-90. Outpatient services have varying copays and coinsurance, with no copay for blood services. Preventive services, primary care, and routine hearing and vision exams also have no copay. The plan covers ambulance services with a $350 copay and offers emergency services with copays. Dental services include no copay for certain services and 50% coinsurance for others. Medical equipment, home health, and dialysis services are covered with coinsurance, and diagnostic and radiological services have copays. The plan also includes OTC benefits, but excludes some services like cardiac rehabilitation and acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-5 of inpatient hospital stays, there is a $415 copay, and for days 6-90, there is no copay; there is no coinsurance for either.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a $30 copay and 20% coinsurance, while observation services have a $450 copay; ASC services have a $30 copay with at least 20% coinsurance. Individual and group sessions for outpatient substance abuse have a $30 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Regence MedAdvantage + Rx Primary (PPO) plan 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 Primary (PPO) plan. Ground and air ambulance services have a $350 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Regence MedAdvantage + Rx Primary (PPO) plan, with a copay of $125 for emergency services and worldwide emergency coverage, and a copay of $45 for urgently needed services. Worldwide emergency transportation has a copay of $350.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services have a $40 copay. Physician Specialist Services have a $30 copay. Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, and Opioid Treatment Program Services have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits have a copay between $0 and $40. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services, including Home-Based Palliative Care, are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $499 and $999, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams, routine eye exams, and eyeglass lenses have no copay. Contact lenses and eyeglass frames are covered with a maximum benefit of $100 per year, and eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $30 copay, 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. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery are covered with a 50% coinsurance, while Adjunctive General Services, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. 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 under the Regence MedAdvantage + Rx Primary (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and authorization required, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Regence MedAdvantage + Rx Primary (PPO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a $30 copay, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $300, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Regence MedAdvantage + Rx Primary (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 not covered by the Regence MedAdvantage + Rx Primary (PPO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Regence MedAdvantage + Rx Primary (PPO), but require prior authorization. For days 1-20, there is a $10 copay, for days 21-42, the copay is $214, and for days 43-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
The "Regence MedAdvantage + Rx Primary (PPO)" plan does not cover 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. The plan covers Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $15.00 every three months, and Meal Benefits for chronic illnesses.
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