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Regence Valiance (PPO)

H1304 - 001 - 0

(3.5 / 5)

Regence Valiance (PPO) is a Medicare Advantage Plan by Regence BlueShield of Idaho.

This page features plan details for 2025 Regence Valiance (PPO) H1304 – 001 – 0.

IMPORTANT: This page features the 2025 version of this plan. See the 2025 version using the link below:

Locations

Regence Valiance (PPO) is offered in the following locations.

Click to see more locations

Plan Overview

Regence Valiance (PPO) offers the following coverage and cost-sharing.

Insurer:	Regence BlueShield of Idaho
Health Plan Deductible:	$0
MOOP:	$10,100 In and Out-of-network $5,500 In-network
Drugs Covered:	No

Ready to sign up for Regence Valiance (PPO) ?

Get help from a licensed insurance agent.

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

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.

Regence Valiance (PPO) qualifies for a monthly Medicare Give Back Benefit of $45.00.

Premium Reduction:

$45.00

Premium Breakdown

Regence Valiance (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.

Part B	Part C	Part B Give Back	Total
$185.00	$0.00	$45.00	$

Please Note:

Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Regence Valiance (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

Comprehensive Dental

Endodontics
- In-Network: 50 Coins – No Co pay
- Out-of-Network: 50% Coins – No Copay
Oral and Maxillofacial Surgery
- In-Network: 50 Coins – No Co pay
- Out-of-Network: 50% Coins – No Copay
Periodontics
- In-Network: 50 Coins – No Co pay
- Out-of-Network: 50% Coins – No Copay
Prosthodontics, removable
- In-Network: 50 Coins – No Co pay
- Out-of-Network: 50% Coins – No Copay
Restorative Services
- In-Network: 50 Coins – No Co pay
- Out-of-Network: 50% Coins – No Copay

Diagnostic and Preventive Dental

Dental X-Rays
- In-Network: No Coins – 0.00 Copay
- Out-of-Network: 50% Coins – No Copay
Fluoride Treatment
- In-Network: No Coins – 0.00 Copay
- Out-of-Network: 50% Coins – No Copay
Oral Exams
- In-Network: No Coins – 0.00 Copay
- Out-of-Network: 50% Coins – No Copay
Other Diagnostic Dental Services
- In-Network: No Coins – 0.00 Copay
- Out-of-Network: 50% Coins – No Copay
Other Preventive Dental Services
- In-Network: No Coins – 0.00 Copay
- Out-of-Network: 50% Coins – No Copay
Prophylaxis (cleaning)
- In-Network: No Coins – 0.00 Copay
- Out-of-Network: 50% Coins – No Copay

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI)
- Out-of-Network: 50% coinsurance (Authorization Required)
Lab services
- In-Network: $0 copay (Authorization Required)
Outpatient x-rays
- In-Network: $5 copay (Authorization Required)
Diagnostic radiology services (e.g., MRI)
- In-Network: $0-300 copay (Authorization Required)
Outpatient x-rays
- Out-of-Network: 50% coinsurance (Authorization Required)
Lab services
- Out-of-Network: 50% coinsurance (Authorization Required)
Diagnostic tests and procedures
- In-Network: $0 copay (Authorization Required)
- Out-of-Network: 50% coinsurance (Authorization Required)

Doctor visits

Primary
- In-Network: $0 copay
Specialist
- In-Network: $35 copay per visit
Primary
- Out-of-Network: 50% coinsurance per visit
Specialist
- Out-of-Network: 50% coinsurance per visit

Emergency care/Urgent care

Emergency
- $125 copay per visit (always covered)
Urgent care
- $30 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment
- In-Network: $35 copay
- Out-of-Network: 50% coinsurance
Routine foot care
- Not covered

Ground ambulance

- In-Network: $275 copay
- Out-of-Network: $275 copay

Health plan deductible

- $0

Hearing

Hearing aids
- Out-of-Network: $499-999 copay (Limits Apply)
Hearing aids OTC
- Not covered
Medicare-Covered Hearing Exam
- In-Network: $35 copay
Fitting/evaluation
- Out-of-Network: $0 copay
Hearing aids
- In-Network: $499-999 copay (Limits Apply)
Fitting/evaluation
- In-Network: $0 copay
Medicare-Covered Hearing Exam
- Out-of-Network: 50% coinsurance

Inpatient hospital coverage

- In-Network: $350 per day for days 1 through 5
  $0 per day for days 6 through 90 (Authorization Required)
- Out-of-Network: 50% per day for days 1 and beyond (Authorization Required)

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

- $10,100 In and Out-of-network
  $5,500 In-network

Medical equipment/supplies

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

Mental health services

Inpatient hospital – psychiatric
- Out-of-Network: 50% per day for days 1 through 190 (Authorization Required)
Outpatient group therapy visit
- Out-of-Network: 50% coinsurance (Authorization Required)
Outpatient individual therapy visit
- In-Network: $25 copay (Authorization Required)
- Out-of-Network: 50% coinsurance (Authorization Required)
Outpatient group therapy visit
- In-Network: $25 copay (Authorization Required)
Outpatient group therapy visit with a psychiatrist
- In-Network: $25 copay (Authorization Required)
- Out-of-Network: 50% coinsurance (Authorization Required)
Inpatient hospital – psychiatric
- In-Network: $350 per day for days 1 through 5
  $0 per day for days 6 through 90 (Authorization Required)
Outpatient individual therapy visit with a psychiatrist
- In-Network: $25 copay (Authorization Required)
- Out-of-Network: 50% coinsurance (Authorization Required)

Optional supplemental benefits

- No

Other health plan deductibles?

- In-Network: No

Outpatient hospital coverage

- Out-of-Network: 50% coinsurance per visit (Authorization Required)
- In-Network: $35 copay or 20% coinsurance per visit (Authorization Required)

Preventive care

- Out-of-Network: 50% coinsurance
- In-Network: $0 copay

Rehabilitation services

Physical therapy and speech and language therapy visit
- In-Network: $15 copay (Authorization Required)
Occupational therapy visit
- Out-of-Network: 50% coinsurance (Authorization Required)
- In-Network: $15 copay (Authorization Required)
Physical therapy and speech and language therapy visit
- Out-of-Network: 50% coinsurance (Authorization Required)

Skilled Nursing Facility

- In-Network: $10 per day for days 1 through 20
  $214 per day for days 21 through 46
  $0 per day for days 47 through 100 (Authorization Required)
- Out-of-Network: 50% per day for days 1 through 100 (Authorization Required)

Transportation

- Not covered

Vision

Contact lenses
- In-Network: $0 copay (Limits Apply)
Eyeglasses (frames and lenses)
- Not covered
Eyeglass frames
- In-Network: $0 copay (Limits Apply)
Eyeglass lenses
- Out-of-Network: $0 copay (Limits Apply)
Routine eye exam
- In-Network: $0 copay (Limits Apply)
- Out-of-Network: 50% coinsurance (Limits Apply)
Contact lenses
- Out-of-Network: $0 copay (Limits Apply)
Eyeglass frames
- Out-of-Network: $0 copay (Limits Apply)
Other
- Not covered
Upgrades
- Not covered
Eyeglass lenses
- In-Network: $0 copay (Limits Apply)

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

- Covered