2022 Regence Valiance (PPO)

Regence Valiance (PPO) H5009-001 is a 2022 Medicare Advantage Plan or Part-C by Regence BlueShield available to residents in Washington. This plan does not provide additional prescription drug (Part-D) coverage. The Regence Valiance (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $6,200 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,200 out-of-pocket. This can be a extremely nice safety net.

Regence Valiance (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 works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Regence Valiance (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Regence BlueShield 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 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 Medicare Advantage Plan Costs

2021 Regence Valiance (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	$0 copay
Diagnostic services	50% coinsurance (Out-of-Network)
Endodontics	50% coinsurance
Endodontics	50% coinsurance (Out-of-Network)
Extractions	50% coinsurance (Out-of-Network)
Extractions	50% coinsurance
Non-routine services	50% coinsurance (Out-of-Network)
Non-routine services	$0 copay
Periodontics	50% coinsurance (Out-of-Network)
Periodontics	50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services	50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services	50% coinsurance (Out-of-Network)
Restorative services	50% coinsurance
Restorative services	50% coinsurance (Out-of-Network)

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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	50% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$20 copay
Lab services	$0-20 copay
Lab services	50% coinsurance (Out-of-Network)
Outpatient x-rays	$20 copay
Outpatient x-rays	50% coinsurance (Out-of-Network)

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Doctor Visits

Primary	$5 copay per visit
Primary	50% coinsurance per visit (Out-of-Network)
Specialist	50% coinsurance per visit (Out-of-Network)
Specialist	$40 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$40 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	50% coinsurance (Out-of-Network)
Foot exams and treatment	$40 copay
Routine foot care	Not covered

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Ground Ambulance

$250 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	$40 copay
Hearing exam	50% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

$390 per day for days 1 through 4 $0 per day for days 5 through 90
50% per day for days 1 and beyond (Out-of-Network)

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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)	50% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
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	20% coinsurance
Other Part B drugs	50% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	$390 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	$40 copay
Outpatient group therapy visit	50% coinsurance (Out-of-Network)
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	$40 copay
Outpatient individual therapy visit with a psychiatrist	50% coinsurance (Out-of-Network)

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MOOP

$10,000 In and Out-of-network $6,200 In-network

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Option

Yes, contact plan for further details

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$40-350 copay per visit
50% coinsurance per visit (Out-of-Network)

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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	$40 copay
Physical therapy and speech and language therapy visit	$40 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 $160 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 Valiance (PPO) H5009

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 Valiance (PPO) Plans Performance

Health Plan Customer Service Rating for Regence Valiance (PPO)

Regence Valiance (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?

Click Here

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

Coverage Area for Regence Valiance (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.