Regence MedAdvantage + Rx Enhanced (PPO)

H1304 - 004 - 0
3.5 out of 5 stars (3.5 / 5)

Regence MedAdvantage + Rx Enhanced (PPO) is a Medicare Advantage (Part C) Plan by Regence BlueShield Of Idaho.

This page features plan details for 2023 Regence MedAdvantage + Rx Enhanced (PPO) H1304 – 004 – 0 available in Select Counties in Idaho/Asotin Co, WA.

IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:

Locations

Regence MedAdvantage + Rx Enhanced (PPO) is offered in the following locations.

Plan Overview

Regence MedAdvantage + Rx Enhanced (PPO) offers the following coverage and cost-sharing.

Insurer:Regence BlueShield Of Idaho
Health Plan Deductible:$0.00
MOOP:$8,300 In and Out-of-network
$5,000 In-network
Drugs Covered:Yes

Ready to sign up for Regence MedAdvantage + Rx Enhanced (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

Regence MedAdvantage + Rx Enhanced (PPO) has a monthly premium of $122.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$164.90 $83.70 $38.30 $0.00 $286.90
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Regence MedAdvantage + Rx Enhanced (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Initial Coverage Limit: $4,660.00
Catastrophic Coverage Limit: $7,400.00
Drug Benefit Type: Enhanced
Gap Coverage: No
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs. The table below shows how the LIS impacts the Part D premium of this plan.
Part D LIS 25% LIS 50% LIS 75% LIS Full
$38.30 $43.40 $34.80 $26.30 $17.70

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

Drug TypeCost Share
Generic drugs$4.15 copay or 5% (whichever costs more)
Brand-name drugs$10.35 copay or 5% (whichever costs more)

Additional Benefits

Regence MedAdvantage + Rx Enhanced (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: Yes, contact plan for further details

Dental (comprehensive)

Diagnostic services:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Diagnostic services:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Endodontics:In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Endodontics:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Extractions:In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Extractions:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Non-routine services:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Non-routine services:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Periodontics:In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Periodontics:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Restorative services:In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Restorative services:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)

Dental (preventive)

Cleaning:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Cleaning:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Oral exam:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Oral exam:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI):In-Network: $0-250 copay (authorization required) (referral not required)
Diagnostic radiology services (e.g., MRI):Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Diagnostic tests and procedures:In-Network: $0 copay (authorization required) (referral not required)
Diagnostic tests and procedures:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Lab services:In-Network: $0 copay (authorization required) (referral not required)
Lab services:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Outpatient x-rays:In-Network: $0 copay (authorization required) (referral not required)
Outpatient x-rays:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

Doctor visits

Primary:In-Network: $0 copay
Primary:Out-of-Network: 30% coinsurance per visit
Specialist:In-Network: $30 copay per visit (authorization not required) (referral not required)
Specialist:Out-of-Network: 30% coinsurance per visit (authorization not required) (referral not required)

Emergency care/Urgent care

Emergency: $90 copay per visit (always covered)
Urgent care: $30 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment:In-Network: $30 copay (authorization not required) (referral not required)
Foot exams and treatment:Out-of-Network: 30% coinsurance (authorization not required) (referral not required)
Routine foot care: Not covered

Ground ambulance

In-Network: $250 copay
Out-of-Network: $250 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation:In-Network: $0 copay (no limits) (authorization not required) (referral not required)
Fitting/evaluation:Out-of-Network: $150 copay (no limits) (authorization not required) (referral not required)
Hearing aids:In-Network: $599-899 copay (limits may apply) (authorization not required) (referral not required)
Hearing aids:Out-of-Network: $599-899 copay (limits may apply) (authorization not required) (referral not required)
Hearing exam:In-Network: $30 copay (authorization not required) (referral not required)
Hearing exam:Out-of-Network: 30% coinsurance (authorization not required) (referral not required)

Hospital coverage (inpatient)

In-Network: $315 per day for days 1 through 5
$0 per day for days 6 through 90 (authorization required) (referral not required)
Out-of-Network: 30% per day for days 1 and beyond (authorization required) (referral not required)

Hospital coverage (outpatient)

In-Network: $30-275 copay per visit (authorization required) (referral not required)
Out-of-Network: 30% coinsurance per visit (authorization required) (referral not required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$8,300 In and Out-of-network
$5,000 In-network

Medical equipment/supplies

Diabetes supplies:In-Network: $0 copay (authorization required)
Diabetes supplies:Out-of-Network: 50% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):In-Network: 20% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):Out-of-Network: 50% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):In-Network: 20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):Out-of-Network: 50% coinsurance per item (authorization required)

Medicare Part B drugs

Chemotherapy:In-Network: 20% coinsurance (authorization required)
Chemotherapy:Out-of-Network: 30% coinsurance (authorization required)
Other Part B drugs:In-Network: 20% coinsurance (authorization required)
Other Part B drugs:Out-of-Network: 30% coinsurance (authorization required)

Mental health services

Inpatient hospital – psychiatric:In-Network: $315 per day for days 1 through 5
$0 per day for days 6 through 90 (authorization required) (referral not required)
Inpatient hospital – psychiatric:Out-of-Network: 30% per day for days 1 through 190 (authorization required) (referral not required)
Outpatient group therapy visit:In-Network: $20 copay (authorization required) (referral not required)
Outpatient group therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist:In-Network: $20 copay (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Outpatient individual therapy visit:In-Network: $20 copay (authorization required) (referral not required)
Outpatient individual therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:In-Network: $20 copay (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

Optional supplemental benefits

No

Preventive care

In-Network: $0 copay (authorization not required) (referral not required)
Out-of-Network: 30% coinsurance (authorization not required) (referral not required)

Rehabilitation services

Occupational therapy visit:In-Network: $10 copay (authorization required) (referral not required)
Occupational therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Physical therapy and speech and language therapy visit:In-Network: $10 copay (authorization required) (referral not required)
Physical therapy and speech and language therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

Skilled Nursing Facility

In-Network: $0 per day for days 1 through 20
$188 per day for days 21 through 47
$0 per day for days 48 through 100 (authorization required) (referral not required)
Out-of-Network: 30% per day for days 1 through 100 (authorization required) (referral not required)

Transportation

Not covered

Vision

Contact lenses:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Contact lenses:Out-of-Network: 0-50% coinsurance (limits may apply) (authorization not required) (referral not required)
Eyeglass frames: Not covered (no limits)
Eyeglass lenses: Not covered (no limits)
Eyeglasses (frames and lenses):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses):Out-of-Network: 0-50% coinsurance (limits may apply) (authorization not required) (referral not required)
Other: Not covered (no limits)
Routine eye exam:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Routine eye exam:Out-of-Network: 30% coinsurance (limits may apply) (authorization not required) (referral not required)
Upgrades: Not covered

Wellness programs (e.g., fitness, nursing hotline)

Covered (authorization not required) (referral not required)

Ready to sign up for Regence MedAdvantage + Rx Enhanced (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

Table of Contents