at a glance
- Regence is a member of the Blue Cross Blue Shield network of insurance companies.
- Regence offers Medicare Advantage plans in four states in the northwestern part of the country.
- Each plan may offer prescription drug coverage as well as additional benefits not covered by original Medicare.
Regence is a health insurance company that’s part of the Blue Cross Blue Shield Association. It provides Medicare Advantage (Part C) health plans to enrollees in the northwestern United States.
Regence offers both Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans to subscribers. It also offers prescription drug or Part D coverage options.
Keep reading to find out more about the plan options and costs that Regence offers by geographic region.
Regence offers two main types of Medicare Advantage plans: HMOs and PPOs. Each has different rules about the healthcare providers you can see and how much you’ll pay when you see them.
The following are some of the key aspects of each type of plan.
Regence HMO plans
An HMO plan involves selecting a primary care physician within the Regence network. If you need to see a specialist, like an orthopedic specialist or a gastroenterologist, you’ll have to see your primary care physician and ask for a referral.
You don’t need a referral, however, to see an in-network gynecologist for preventive care visits or annual screenings.
Typically speaking, HMO plans are less-expensive than PPOs. This is because the provider network is limited to specific providers that have an agreement with the plan to offer cost savings.
Regence PPO plans
A PPO plan doesn’t require you to get a referral to see a medical specialist.
You can see doctors who are in network to get the greatest cost savings, but you can also see an out-of-network doctor if you’d like. Be aware that if you see a doctor out of network, you’ll likely have higher copay costs.
Because PPOs have greater flexibility in terms of which doctors you can see and not needing referrals, you can expect that the premium may be higher than with an HMO plan.
Medicare requires all enrollees to have some form of creditable drug coverage. Individual prescription drug plans are called Part D plans.
Medicare Advantage plans may include prescription drug coverage along with their other coverage. Regence offers many of these Medicare Advantage plans with a $0 premium.
Whether you purchase a separate Part D plan from Regence or choose a Medicare Advantage plan that also has prescription drug coverage, each plan will have a formulary. This is a list of medications that the plan covers.
A Regence Part D plan will usually separate the medications on its formulary into tiers. For Regence, these tiers include:
- Tier 1: preferred generic
- Tier 2: generic
- Tier 3: preferred brand
- Tier 4: nonpreferred drug
- Tier 5: specialty
Generic medications will be the least expensive, while specialty tiers will cost the most. When deciding on a plan, look at the medications you currently take and see if the plan you’re considering covers them.
Like Medicare Advantage plans, Part D plans have star ratings, which can help you compare them.
Regence offers Medicare Advantage plans in the following states:
However, the plans are specific to certain areas. This means you may live in one of the ZIP codes where a plan is offered, but the same plan might not be available in another area serviced by Regence.
To find out which plans are offered in your area, you can use Medicare’s plan finder tool.
One of the reasons people choose Medicare Advantage plans is because they offer additional benefits compared to original Medicare. For Regence, these added benefits may include:
- dental services, such as preventive dental care and problem-focused exams
- hearing services, such as routine hearing exams and hearing aids
- vision services, such as routine eye exams and eyeglasses or contact lenses
- Silver&Fit Exercise & Healthy Aging Program, which is membership to a fitness center and the YMCA, as well as a home fitness kit
- visitor/traveling program for those with certain PPO plans, where you can receive in-network health services even when traveling to participating state networks
- Advice24, a 24-hour nurse call line, where you can access medical advice for some injuries and illnesses as well as when to seek emergency or urgent care treatments
Not all Regence plans offer these benefits. Read the benefits summary carefully so you can determine which ones you may need.
The table below compares costs for different plans in Regence’s coverage area. These costs can help you get an idea of how much you might expect to pay if you were to participate in a Regence Medicare Advantage plan.
|Seattle, WA: Regence BlueAdvantage HMO||Portland, OR: Regence Valiance (HMO)||Boise, ID: Regence Blue MedAdvantage HMO Plus (HMO)||Homedale, ID: Regence MedAdvantage + Rx Classic (PPO)||Provo, UT: Regence MedAdvantage + Rx Enhanced (PPO)|
|Drug deductible||$250||drugs not covered||$150||$200||$0|
|Out-of-pocket max||$6,500 in network||$4,900 in network||$5,500 in network||$5,500 in network, $10,000 in and out of network||$5,900 in network, $10.000 in and out of network|
|Primary doctor visit copay||$0||$0||$0||$0 in network; 30% coinsurance out of network||$0 in network; 30% coinsurance out of network|
|Specialist visit copay||$40||$35||$30||$45 in network; 30% coinsurance out of network||$35 in network; 30% coinsurance out of network|
Medicare Advantage (Part C) is a plan type where a private insurance company fulfills your Part A and Part B Medicare benefits.
Medicare will pay your insurance company of choice a certain amount to provide your benefits. In return, you can choose from different plans that include prescription drug coverage and some services that original Medicare may not cover.
It’s important to note that you’ll still pay your Part B premium to Medicare, even with a Medicare Advantage plan. You may also have a separate premium for your Medicare Advantage plan.
Medicare Advantage plans have key time periods during the year when you can enroll. These include:
- Initial enrollment period: 3 months before the month of your birthday up until 3 months after your birth month
- Medicare open enrollment period: October 15 through December 7
- Medicare Advantage open enrollment period: January 1 to March 31
Regence Medicare Advantage plans are an option if you want extra benefits in addition to original Medicare.
As a member of the Blue Cross Blue Shield network, you may have access to greater perks that a larger company can offer, such as insurance coverage when you travel outside your home state.
To find out if Regence offers a plan in your area, you can use Medicare’s online plan finder tool, or you can contact Regence directly to learn more about plans in your area.