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Regence BlueAdvantage HMO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence BlueAdvantage HMO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Regence BlueAdvantage HMO (HMO) in 2026, please refer to our full plan details page.
Regence BlueAdvantage HMO (HMO) is a HMO plan offered by Cambia Health Solutions, Inc. available for enrollment in 2025 to people living in Select Counties in Oregon. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Regence BlueAdvantage HMO (HMO) 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 BlueAdvantage HMO (HMO).
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 BlueAdvantage HMO (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $50.00 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 Maximum Out-Of-Pocket cost of $6700.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 BlueAdvantage HMO (HMO)
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Drug Coverage
The Regence BlueAdvantage HMO (HMO) plan features a low $50 drug deductible and offers highly affordable options for generic medications. For Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs, members pay no copay when using preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options are also budget-friendly, with copays starting at just $2 for Tier 1 and $3 for Tier 2 medications. For Tier 3 (Preferred Brand) drugs, copays start at $18 at preferred pharmacies and $23 at standard pharmacies for a one-month supply. Tier 4 (Non-Preferred Drug) medications require a 30% coinsurance at preferred pharmacies and 33% at standard pharmacies. Tier 5 (Specialty Tier) drugs have a flat 30% coinsurance across all pharmacy and mail-order types for a one-month supply.
Additional Benefits
The Regence BlueAdvantage HMO (HMO) plan offers comprehensive coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, preventive care, and home health services. Specialist visits require a $45 copay with no coinsurance, while inpatient hospital stays incur a daily copay for the first six days before transitioning to no copay for days seven through ninety. Emergency room and urgent care visits are also covered with flat copayments and no coinsurance. For supplemental benefits, the plan covers routine dental, vision, and hearing exams with no copay or coinsurance, alongside allowances for hardware like hearing aids and contacts. Diagnostic lab work is available with no copay, whereas durable medical equipment and dialysis services require coinsurance with no copay. It is important to note that this plan does not cover cardiac rehabilitation, acupuncture, or over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Regence BlueAdvantage HMO (HMO) with no coinsurance, requiring a copay of $395 per day for days 1 through 6 for acute stays and $380 per day for days 1 through 6 for psychiatric stays, with no copay for days 7 through 90. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Regence BlueAdvantage HMO (HMO) covers outpatient services, including outpatient hospital services for a $45 copay and 20% coinsurance, and ambulatory surgical center services for a $45 copay with no coinsurance. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Regence BlueAdvantage HMO (HMO) plan with a $130.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Regence BlueAdvantage HMO (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. For transportation, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Regence BlueAdvantage HMO (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent services are covered with a $130 copay and no coinsurance, while worldwide emergency transportation has a $300 copay and no coinsurance.
Primary Care See details
Regence BlueAdvantage HMO (HMO) provides primary care physician services and select telehealth benefits with no copay and no coinsurance, while podiatry and routine chiropractic services are not covered. Specialist visits require a $45 copay, and physical, occupational, and speech therapy services have a $40 copay, all with no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Regence BlueAdvantage HMO (HMO) with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, and home-based palliative care. Several supplemental benefits are not covered under this plan, such as health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are partially covered under the Regence BlueAdvantage HMO (HMO) plan, featuring routine exams and fitting evaluations with no copay and no coinsurance, and Medicare-covered exams for a $45 copay and no coinsurance. Prescription hearing aids are covered with copays between $499 and $999 and no coinsurance for up to two devices per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Regence BlueAdvantage HMO (HMO) vision services are partially covered with no copay, no coinsurance, and no deductible for covered services. The plan covers one annual routine eye exam, eyeglass lenses, and up to $100 yearly for frames or contact lenses, but other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Regence BlueAdvantage HMO (HMO) partially covers dental services up to a $1,000 annual maximum, offering preventive care with no copay or coinsurance and Medicare-covered dental for a $45 copay and no coinsurance. Select comprehensive services are covered with no copay and a 50% coinsurance, while implants, orthodontics, fixed prosthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Regence BlueAdvantage HMO (HMO) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Under this benefit, Medicare Part B drugs like chemotherapy and radiation carry up to 20% coinsurance, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Regence BlueAdvantage HMO (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Regence BlueAdvantage HMO (HMO) covers durable medical equipment with no copay and 25% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance, though prior authorization is required for medical equipment and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Regence BlueAdvantage HMO (HMO) covers diagnostic and radiological services, though prior authorization is required for these benefits. Diagnostic procedures and tests require a $20 copay and no coinsurance, while lab services and diagnostic radiological services are available with no copay and no coinsurance. Outpatient X-rays require a $15 copay with coinsurance, and therapeutic radiological services incur a 20% coinsurance.
Home Health Services See details
Regence BlueAdvantage HMO (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Regence BlueAdvantage HMO (HMO) plan, which provides no coverage for intensive cardiac, pulmonary, or supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
Regence BlueAdvantage HMO (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 42, and no copay for days 43 to 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are not covered under the Regence BlueAdvantage HMO (HMO) plan, including acupuncture, over-the-counter (OTC) items, and meal benefits. Since these benefits are not covered, members will be responsible for the full cost of these services.
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