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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 $100.00. 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) plan features a $615 annual drug deductible. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies and preferred mail-order services, while standard pharmacies charge a $3 copay for a one-month supply. Tier 2 generic medications cost as low as a $4 copay for a one-month supply at preferred locations, and there is no copay for a three-month supply filled through preferred mail order. Higher-tier medications are subject to coinsurance rather than flat copays. Tier 3 preferred brands carry a 19% coinsurance at preferred pharmacies and 23% at standard pharmacies, while Tier 4 non-preferred drugs require 36% coinsurance at preferred pharmacies and 39% at standard pharmacies. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers affordable access to essential medical services, featuring a low $10 copay for primary care visits and a $45 copay for specialists with no coinsurance. For hospital care, inpatient stays carry a $455 daily copay for the first five days and no copay thereafter, while emergency room visits require a $130 copay. Outpatient hospital services generally incur a $45 copay along with 20% coinsurance. This plan also provides valuable supplemental coverage, including preventive care, vision exams, and home health services with no copays or coinsurance. Dental benefits include a $1,000 annual limit with no copay for preventive services and a 50% coinsurance for comprehensive care, while hearing aids require copays ranging from $499 to $999. Durable medical equipment is available with no copay and a 40% coinsurance, helping you manage out-of-pocket costs for your daily health needs.
Inpatient Hospital See details
Regence MedAdvantage + Rx Primary (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, featuring a $455 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Regence MedAdvantage + Rx Primary (PPO) covers outpatient hospital services with a $45 copay and 20% coinsurance, and hospital observation services with a $450 copay per stay. Ambulatory surgical center services require a $45 copay with no coinsurance, outpatient substance abuse sessions carry a $30 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Regence MedAdvantage + Rx Primary (PPO) 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 ground and air ambulance services with a $350 copay and no coinsurance, subject to prior authorization. Routine transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Regence MedAdvantage + Rx Primary (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 care are also covered with a $130 copay, and worldwide emergency transportation is available with a $350 copay, all with no coinsurance.
Primary Care See details
Regence MedAdvantage + Rx Primary (PPO) covers primary care doctor visits for a $10 copay and specialist visits for a $45 copay, both with no coinsurance. Mental health, psychiatric, and physical therapy services are also covered with copays ranging from $30 to $45 and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Regence MedAdvantage + Rx Primary (PPO) preventive services are partially covered, offering no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and select screenings. Multiple additional services are not covered, including health education, in-home safety assessments, personal emergency response systems, 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.
Hearing Services See details
Hearing services are partially covered by Regence MedAdvantage + Rx Primary (PPO) with no deductible and no coinsurance. Medicare-covered exams require a $45 copay, routine exams and fitting evaluations have no copay, and covered prescription hearing aids carry a $499 to $999 copay, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Regence MedAdvantage + Rx Primary (PPO) provides partially covered vision services with no copay, no coinsurance, and no deductible for covered care. This benefit includes one routine eye exam, one pair of eyeglass lenses, and up to $100 annually for contact lenses or eyeglass frames, while other eye exams and eyewear upgrades are not covered.
Dental Services See details
Regence MedAdvantage + Rx Primary (PPO) covers dental services up to a $1,000 annual limit, with no copay and no coinsurance for preventive care, and a $45 copay and no coinsurance for Medicare-covered dental. Comprehensive dental is partially covered with no copay and 50% coinsurance for restorative, endodontics, periodontics, removable prosthodontics, and oral surgery, while adjunctive general services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Regence MedAdvantage + Rx Primary (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Regence MedAdvantage + Rx Primary (PPO) covers Dialysis Services 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, while prosthetics and medical supplies are covered with no copay and 20% coinsurance. Diabetic equipment and supplies are covered with no copay and no coinsurance, subject to prior authorization and manufacturer limitations.
Diagnostic and Radiological Services See details
Regence MedAdvantage + Rx Primary (PPO) covers diagnostic and radiological services with prior authorization required. Under this plan, diagnostic tests require a $30 copay with no coinsurance, outpatient x-rays incur a $25 copay plus coinsurance, and therapeutic radiology has a 20% coinsurance, while lab services and diagnostic radiology 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 copay and no coinsurance, meaning some services are covered; however, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Regence MedAdvantage + Rx Primary (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond the 100-day Medicare limit are not covered. You will pay a $10 daily copay for days 1 through 20, a $218 daily copay for days 21 through 50, and no copay for days 51 through 100, with no prior three-day hospital stay required.
Other Services See details
Other Services are not covered under the Regence MedAdvantage + Rx Primary (PPO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded. Since these services are not covered, members are responsible for the full cost of these services and do not have copay or coinsurance options.
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