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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 $66.00. 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 $14000.00 (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 $14000.00 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:
Sign up for Regence MedAdvantage + Rx Primary (PPO)
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Drug Coverage
The Regence MedAdvantage + Rx Primary (PPO) plan has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy you use. For preferred generic drugs, you'll pay a $10 copay at a preferred pharmacy, and $13 at a standard pharmacy. For standard generic drugs, you'll pay 22% coinsurance at a preferred pharmacy, and 25% coinsurance at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Regence MedAdvantage + Rx Primary (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays and coinsurance. The plan also covers primary care, preventive services, hearing, vision, and dental services, often with no copay or a low copay. Additional benefits include ambulance, emergency, and home health services, with specific copays or coinsurance. The plan also covers medical equipment, diagnostic and radiological services, and skilled nursing facility stays. Some services like OTC items and meal benefits are covered, while others, such as additional hours of care and personal care services, are not.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $425 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $387 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional Days and Upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, and Non-Medicare-covered Stay for Inpatient Hospital-Acute and 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 $450 copay, Ambulatory Surgical Center (ASC) Services with a $35 copay and 20% coinsurance, Outpatient Substance Abuse Services including individual and group sessions with a $30 copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Regence MedAdvantage + Rx Primary (PPO) plan, with an $80 copay. 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. 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. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $350 copay; all services have no coinsurance.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with a $10 copay, Chiropractic Services with a $15 copay (excluding routine care), Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $35 copay, and Mental Health Specialty Services, Individual and Group Sessions with a $30 copay. Other Health Care Professional services have a $20 copay, Psychiatric Services, Individual and Group Sessions have a $30 copay, Physical Therapy and Speech-Language Pathology Services have a $35 copay, Additional Telehealth Benefits have a $10-$35 copay, and Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive Services include coverage for many services, including annual physical exams with no copay, and additional preventive services, kidney disease education services, and other preventive services. Additional preventive services, kidney disease education services, and other preventive services have a copay, but the exact amount is not specified. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
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, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have no copay. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames with no copay, while eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, and a yearly maximum of $1,000 for other dental services. Oral exams and dental x-rays have no copay, with limitations on the number of visits per year, while restorative services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery have a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Regence MedAdvantage + Rx Primary (PPO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics, and Medical Supplies. For DME, there is a 20% coinsurance with prior authorization required, 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, including diagnostic procedures/tests with a $30 copay, lab services with no copay, and outpatient X-ray services with a $20 copay. Diagnostic radiological services have a maximum copay of $300, while therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under 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 covered, but the specific services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for these services, but the specific amount is not detailed in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20 and 54-100, there is no copay, while days 21-53 have a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are partially covered by the Regence MedAdvantage + Rx Primary (PPO) plan. 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 are not covered. Over-the-Counter (OTC) Items and Meal Benefits are covered. The plan provides up to $15 every three months for Over-the-Counter (OTC) items.
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