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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 2025, 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 Lane County. This plan received an overall rating of 3 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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:
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Drug Coverage
The Regence BlueAdvantage HMO (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different amounts depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and no copay with preferred mail order, while standard generic drugs have an $18 copay at preferred pharmacies. 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 BlueAdvantage HMO (HMO) plan offers a range of benefits with varying costs. Hospital stays have a copay, while outpatient services include copays and coinsurance depending on the service. Primary care visits have no copay, and preventive services, including an annual physical, are also covered with no copay. This plan also covers hearing, vision, and dental services, with some services having no copay and others with copays or coinsurance. There are also benefits for ambulance, emergency, and home health services. Additionally, the plan includes coverage for medical equipment, diagnostic services, and other services like OTC items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $395 for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric also has a copay of $380 for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a $45 copay and 20% coinsurance, while observation services have a $400 copay. Ambulatory Surgical Center (ASC) Services have a $45 copay and 20% coinsurance. Outpatient substance abuse services have a $35 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Regence BlueAdvantage HMO (HMO) plan, with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $250 copay, and 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 by the Regence BlueAdvantage HMO (HMO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency and Urgent Coverage, and $250 for Worldwide Emergency Transportation.
Primary Care See details
The Regence BlueAdvantage HMO (HMO) plan covers primary care physician services with no copay and covers chiropractic services with a $20 copay. Occupational therapy services have a $35 copay, physician specialist services have a $45 copay, and physical therapy and speech-language pathology services have a $35 copay. Mental health and psychiatric services have a copay ranging from $0 to $35.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with varying copays. This plan also covers Home-Based Palliative Care, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Fitness Benefit with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 Services include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) 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 over-the-counter hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams, routine eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams, routine eye exams, and eyeglass lenses have no copay, while contact lenses and eyeglass frames are covered. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Regence BlueAdvantage HMO (HMO) plan covers Medicare dental services with a $45 copay and covers other dental services with a $1,000 maximum, per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments are covered with no copay, and a limit on the number of visits per year. Restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Regence BlueAdvantage HMO (HMO), and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Regence BlueAdvantage HMO (HMO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered by the Regence BlueAdvantage HMO (HMO) plan, with a 20% coinsurance for Durable Medical Equipment and Prosthetic Devices, and no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a $20 copay, lab services with no copay, diagnostic radiological services with a copay up to $300, therapeutic radiological services with a coinsurance of at least 20%, and outpatient X-ray services with a $10 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Regence BlueAdvantage HMO (HMO) with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The copay for services is not specified in this summary.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Regence BlueAdvantage HMO (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, for days 21-37, the copay is $214, and for days 38-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and a Meal Benefit, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered. The OTC benefit provides up to $15 every three months, and the Meal Benefit is for a chronic illness.
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