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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 2026, 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 2026.
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 $84.00. 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 $615.00 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) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through preferred mail order, while standard pharmacies charge a $3 copay for a one-month supply. Tier 2 generic drugs cost a low copay of $4 at preferred pharmacies and feature no copay for a three-month supply when using preferred mail order. Higher tier medications under this plan are covered using coinsurance rates instead of flat copays. Tier 3 preferred brands require a 19% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 36% coinsurance. Specialty medications in Tier 5 are subject to a 25% coinsurance for a one-month supply across both preferred and standard network pharmacies.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers robust core medical coverage with no copay for primary care visits and preventive services. Specialty care and outpatient hospital services generally carry a $45 copay, while emergency room visits require a $130 copay. For inpatient hospital stays, members pay a $455 daily copay for the first five days and no copay for days six through ninety. This plan also features key ancillary benefits, including routine vision exams and eyewear with no copay up to a $100 annual limit, alongside preventive dental care with no copay. Comprehensive dental services are covered up to a $1,000 annual maximum with 50% coinsurance, and hearing aids require a copay between $499 and $999. Note that certain benefits such as transportation, acupuncture, and over-the-counter items are not covered.
Inpatient Hospital See details
Regence MedAdvantage + Rx Primary (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $455 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered as additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Regence MedAdvantage + Rx Primary (PPO) covers outpatient hospital services with a $45 copay and 20% coinsurance, and ambulatory surgical center services with a $45 copay and no coinsurance. The plan also covers outpatient substance abuse sessions for a $30 copay with no coinsurance, observation services for a $450 copay per stay, and blood services with no copay or coinsurance.
Partial Hospitalization See details
Regence MedAdvantage + Rx Primary (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 Primary (PPO) covers Medicare-covered ground and air ambulance services with a $350 copay and no coinsurance, subject to prior authorization. Transportation services are not covered under this plan.
Emergency Services See details
Regence MedAdvantage + Rx Primary (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 48 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency and urgent care have a $130 copay, and worldwide emergency transportation has a $350 copay, all with no coinsurance.
Primary Care See details
Regence MedAdvantage + Rx Primary (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $45 copay and no coinsurance. Mental health and psychiatric services are covered with a $30 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Regence MedAdvantage + Rx Primary (PPO) with no copays and no coinsurance for annual physical exams, kidney disease education, and home-based palliative care. While memory fitness and remote access technologies are also covered, the benefit is only partially covered as services like health education, in-home safety assessments, nutritional/dietary benefits, and counseling are not covered.
Hearing Services See details
Regence MedAdvantage + Rx Primary (PPO) partially covers hearing services with no deductible, offering Medicare-covered exams for a $45 copay and no coinsurance, alongside one routine exam per year and unlimited fitting evaluations for no copay and no coinsurance. Up to two prescription hearing aids are covered annually with a copay ranging from $499 to $999 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Regence MedAdvantage + Rx Primary (PPO) with no copay, no coinsurance, and no deductible for annual routine eye exams, eyeglass lenses, eyeglass frames, and contact lenses. This benefit is partially covered because other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered, and frames and contact lenses are subject to a $100 annual limit.
Dental Services See details
Regence MedAdvantage + Rx Primary (PPO) dental services are partially covered up to a $1,000 annual maximum, offering Medicare-covered dental for a $45 copay and no coinsurance, alongside preventive care with no copay and no coinsurance. Comprehensive services such as restorative, endodontics, periodontics, removable prosthodontics, and oral surgery are covered with 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
Home infusion bundled services are covered by Regence MedAdvantage + Rx Primary (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Regence MedAdvantage + Rx Primary (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Regence MedAdvantage + Rx Primary (PPO) covers durable medical equipment with no copay and 40% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment and supplies are available with no copay and no coinsurance from specified manufacturers, with prior authorization required for all medical equipment categories.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Regence MedAdvantage + Rx Primary (PPO), with prior authorization required. Diagnostic tests and procedures require a $30 copay with no coinsurance, outpatient X-rays have a $25 copay, and therapeutic radiological services carry a 20% coinsurance, while lab services and diagnostic radiological services are offered with no copay and no coinsurance.
Home Health Services See details
Regence MedAdvantage + Rx Primary (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Regence MedAdvantage + Rx Primary (PPO) covers cardiac rehabilitation services with no coinsurance; however, only some services are covered, and standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Regence MedAdvantage + Rx Primary (PPO) 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 50, and no copay for days 51 to 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Regence MedAdvantage + Rx Primary (PPO) does not cover other services, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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