2022 Regence MedAdvantage + Rx Primary (PPO)

Regence MedAdvantage + Rx Primary (PPO) H1304-011 is a 2022 Medicare Advantage Plan or Part-C by Regence BlueShield Of Idaho available to residents in Idaho and Washington. This plan includes additional prescription drug (Part-D) coverage. The Regence MedAdvantage + Rx Primary (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,500 out-of-pocket. This can be a extremely nice safety net.

Regence MedAdvantage + Rx Primary (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Regence BlueShield Of Idaho works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Regence MedAdvantage + Rx Primary (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Regence BlueShield Of Idaho and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Regence BlueShield Of Idaho except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Regence BlueShield Of Idaho Medicare Advantage Plan Costs

Regence MedAdvantage + Rx Primary (PPO) Part-C Premium

Regence BlueShield Of Idaho charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H1304-011 Part-D Deductible and Premium

Regence MedAdvantage + Rx Primary (PPO) has a monthly drug premium of $0.00 and a $200.00 drug deductible. This Regence BlueShield Of Idaho plan offers a $0.00 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Regence BlueShield Of Idaho above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Regence BlueShield Of Idaho Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Regence BlueShield Of Idaho plan does not offer additional coverage through the gap.

H1304-011 Formulary or Drug Coverage

Regence MedAdvantage + Rx Primary (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Regence MedAdvantage + Rx Primary (PPO) H1304-011 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$0	$10
Tier 2	$13	$20
Tier 3	$40	$47
Tier 4	40%	45%
Tier 5	29%	29%

*Initial Coverage Phase and 30 day supply

2021 Regence MedAdvantage + Rx Primary (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	Not covered

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	20% coinsurance
Diagnostic radiology services (e.g., MRI)	50% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$10 copay
Diagnostic tests and procedures	50% coinsurance (Out-of-Network)
Lab services	$0-10 copay
Lab services	50% coinsurance (Out-of-Network)
Outpatient x-rays	50% coinsurance (Out-of-Network)
Outpatient x-rays	$15 copay

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Doctor Visits

Primary	50% coinsurance per visit (Out-of-Network)
Primary	$10 copay per visit
Specialist	$45 copay per visit
Specialist	50% coinsurance per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$45 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$45 copay
Foot exams and treatment	50% coinsurance (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$275 copay
$275 copay (Out-of-Network)

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Hearing

Fitting/evaluation	Not covered
Hearing aids	$699-999 copay
Hearing aids	$699-999 copay (Out-of-Network)
Hearing exam	$45 copay
Hearing exam	50% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

50% per day for days 1 and beyond (Out-of-Network)
$400 per day for days 1 through 4 $0 per day for days 5 through 90

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Medical Equipment/Supplies

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

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	50% coinsurance (Out-of-Network)
Other Part B drugs	50% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$400 per day for days 1 through 4 $0 per day for days 5 through 90
Inpatient hospital - psychiatric	50% per day for days 1 through 190 (Out-of-Network)
Outpatient group therapy visit	50% coinsurance (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	50% coinsurance (Out-of-Network)
Outpatient individual therapy visit	50% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	50% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay

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MOOP

$10,000 In and Out-of-network $5,500 In-network

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Option

Yes, contact plan for further details

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Optional supplemental benefits

Yes

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Outpatient Hospital Coverage

$45-300 copay per visit
50% coinsurance per visit (Out-of-Network)

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Package #1

Deductible
Monthly Premium	$24.00

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Preventive Care

50% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

Cleaning	$0 copay
Cleaning	50% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Dental x-ray(s)	50% coinsurance (Out-of-Network)
Fluoride treatment	$0 copay
Fluoride treatment	50% coinsurance (Out-of-Network)
Oral exam	50% coinsurance (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	50% coinsurance (Out-of-Network)
Occupational therapy visit	$20 copay
Physical therapy and speech and language therapy visit	$20 copay
Physical therapy and speech and language therapy visit	50% coinsurance (Out-of-Network)

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Skilled Nursing Facility

$0 per day for days 1 through 20 $167 per day for days 21 through 100
50% per day for days 1 through 100 (Out-of-Network)

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Transportation

Not covered

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Vision

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

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Regence MedAdvantage + Rx Primary (PPO) H1304

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Regence MedAdvantage + Rx Primary (PPO) Plans Performance

Health Plan Customer Service Rating for Regence MedAdvantage + Rx Primary (PPO)

Regence MedAdvantage + Rx Primary (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

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1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Regence MedAdvantage + Rx Primary (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.