In-network
Inpatient hospital
Days 1–5 $450 / day
Days 6–90 $0 / day
Total of listed copays · 5 charged days $2,250
Out-of-network
Tier 1: 50% coinsurance for days 1–999; 0% coinsurance
Point of service
Not separately reported
● CMS 2027 plan record
Regence MedAdvantage + Rx Primary (PPO)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network$300 copay
Air · in-network$300 copay
Emergency services
Emergency room
$130 copay
Waived if admitted within 48 hours
Medical maximum
Maximum out-of-pocket
In-network$7,150
Combined in + out$10,100
Skilled care at home
Home health
In-network$0 copay
Out-of-network50% coinsurance
Monthly cost
Premium & giveback
Part C premium$46.50 / month
Consolidated C + D$62 / month
CMS reports no Part B premium reduction for this plan.
Quick view
Primary care physician
In: Primary Care Physician Services: $0 copay · Out: 7a: 50% coinsurance
Quick view
Specialist
In: Physician Specialist Services: $45 copay · Out: 7d: 50% coinsurance
Quick view
Preventive care
In: Annual Physical Exam: $0 copay; Kidney Disease Education Services: $0 copay; Glaucoma Screening: $0 copay; Diabetes Self-Management Training: $0 copay; Digital Rectal Exams: $0 copay; EKG following Welcome Visit: $0 copay · Out: 14b: 50% coinsurance; 14d: 50% coinsurance; 14e1: 50% coinsurance; 14e2: 50% coinsurance; 14e4: 50% coinsurance; 14e5: 50% coinsurance; 14a: 50% coinsurance
Quick view
Diagnostic procedures & tests
In: Diagnostic Procedures/Tests: $40 copay · Out: 8a1: 50% coinsurance
Quick view
Laboratory services
In: Lab Services: $0–$35 copay · Out: 8a2: 50% coinsurance
Quick view
X-rays & standard imaging
In: Outpatient X-Ray Services: $25 copay · Out: 8b3: 50% coinsurance
Quick view
MRI, CT & PET imaging
In: Diagnostic Radiological Services: $0–$300 copay · Out: 8b1: 50% coinsurance
Quick view
Urgent care
In: Urgently Needed Services: $50 copay · Out: Not separately reported
Quick view
Emergency room
In: $130 copay · Out: Not separately reported
Quick view
Ground ambulance
In: $300 copay · Out: $300 copay
Quick view
Air ambulance
In: $300 copay · Out: $300 copay
Quick view
Outpatient hospital
In: Outpatient Hospital Services: 20% coinsurance + $0–$45 copay; Observation Services: $450 copay · Out: 9a1: 50% coinsurance; 9a2: 50% coinsurance
Quick view
Outpatient surgery / ASC
In: Ambulatory Surgical Center (ASC) Services: $0–$395 copay · Out: 9b: 50% coinsurance
Quick view
Home health
In: $0 copay · Out: 50% coinsurance
Quick view
Skilled nursing facility
In: Skilled nursing facility: Tier 1: $10 / day for days 1–20; $218 / day for days 21–51; $0 / day for days 52–100 · Out: Skilled nursing facility: Tier 1: 50% coinsurance for days 1–100; 0% coinsurance
Quick view
Cardiac & pulmonary rehabilitation
In: Cardiac Rehabilitation Services: $40 copay; Intensive Cardiac Rehabilitation Services: $40 copay; Pulmonary Rehabilitation Services: $15 copay; SET for PAD Services: $25 copay; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable · Out: 3-1: 50% coinsurance; 3-2: 50% coinsurance; 3-3: 50% coinsurance; 3-4: 50% coinsurance
Quick view
Occupational therapy
In: Occupational Therapy Services: $40 copay · Out: 7c: 50% coinsurance
Quick view
Physical & speech therapy
In: Physical Therapy and Speech-Language Pathology Services: $40 copay · Out: 7i: 50% coinsurance
Quick view
Mental health services
In: Partial Hospitalization Program: $130 copay; Individual Sessions for Mental Health Specialty Services: $45 copay; Group Sessions for Mental Health Specialty Services: $45 copay; Individual Sessions for Psychiatric Services: $45 copay; Group Sessions for Psychiatric Services: $45 copay; Inpatient psychiatric hospital: Tier 1: $450 / day for days 1–5; $0 / day for days 6–90 · Out: 5a: 50% coinsurance; 7e1: 50% coinsurance; 7e2: 50% coinsurance; 7h1: 50% coinsurance; 7h2: 50% coinsurance; Inpatient psychiatric hospital: Tier 1: 50% coinsurance for days 1–190; 0% coinsurance
Quick view
Substance use treatment
In: Intensive Outpatient Program Services: $130 copay; Individual Sessions for Outpatient Substance Abuse: $45 copay; Group Sessions for Outpatient Substance Abuse: $45 copay · Out: 5b: 50% coinsurance; 9c1: 50% coinsurance; 9c2: 50% coinsurance
Quick view
Podiatry
In: Podiatry Services: $45 copay; 7f(NMC): Not applicable · Out: 7f: 50% coinsurance
Quick view
Chiropractic
In: Chiropractic Services: $15 copay · Out: 7b: 50% coinsurance
Quick view
Dental
In: Medicare Dental Services: $45 copay; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 copay; Dental X-Rays: $0 copay; Other Diagnostic Dental Services: $0 copay; Prophylaxis (Cleaning): $0 copay; Fluoride Treatment: $0 copay; Other Preventive Dental Services: $0 copay; Restorative Services: 50% coinsurance; Endodontics: 50% coinsurance; Periodontics: 50% coinsurance; Prosthodontics, removable: 50% coinsurance; Oral and Maxillofacial Surgery: 50% coinsurance · Out: 16a: 50% coinsurance; 16b1: 50% coinsurance; 16b2: 50% coinsurance; 16b3: 50% coinsurance; 16b4: 50% coinsurance; 16b5: 50% coinsurance; 16b6: 50% coinsurance; 16c1: 50% coinsurance; 16c2: 50% coinsurance; 16c3: 50% coinsurance; 16c4: 50% coinsurance; 16c8: 50% coinsurance
Quick view
Vision
In: Eye Exams: $0 copay; Routine Eye Exams: $0 copay; Other Eye Exam Services: Not applicable; Eyewear: $0 copay; Eyeglasses (lenses and frames): Not applicable; Eyeglass lenses: $0 copay; Upgrades: Not applicable · Out: 17a: 50% coinsurance; 17a1: 50% coinsurance; 17b: 50% coinsurance; 17b1: $0 cost share; 17b3: 50% coinsurance; 17b4: $0 cost share
Quick view
Hearing
In: Hearing Exams: $45 copay; Routine Hearing Exams: $0 copay; Fitting/Evaluation for Hearing Aid: $0 copay; Prescription Hearing Aids (all types): $499–$999 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable · Out: 18a: 50% coinsurance; 18a1: 80% coinsurance; 18a2: 80% coinsurance; 18b1: 80% coinsurance
Quick view
Transportation
In: 10b(NMC): Not applicable · Out: Not separately reported
Quick view
Fitness & wellness
In: Not separately reported · Out: 14c4: 80% coinsurance
Quick view
Over-the-counter allowance
In: Over-the-Counter (OTC) Items: Not applicable · Out: Not separately reported
Quick view
Meals
In: Meal Benefit: Not applicable · Out: Not separately reported
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
In-networkPrimary Care Physician Services: $0 copay
Out-of-network7a: 50% coinsurance
Specialist
In-networkPhysician Specialist Services: $45 copay
Out-of-network7d: 50% coinsurance
Preventive care
In-networkAnnual Physical Exam: $0 copay; Kidney Disease Education Services: $0 copay; Glaucoma Screening: $0 copay; Diabetes Self-Management Training: $0 copay; Digital Rectal Exams: $0 copay; EKG following Welcome Visit: $0 copay
Out-of-network14b: 50% coinsurance; 14d: 50% coinsurance; 14e1: 50% coinsurance; 14e2: 50% coinsurance; 14e4: 50% coinsurance; 14e5: 50% coinsurance; 14a: 50% coinsurance
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-networkDiagnostic Procedures/Tests: $40 copay
Out-of-network8a1: 50% coinsurance
Laboratory services
In-networkLab Services: $0–$35 copay
Out-of-network8a2: 50% coinsurance
X-rays & standard imaging
In-networkOutpatient X-Ray Services: $25 copay
Out-of-network8b3: 50% coinsurance
MRI, CT & PET imaging
In-networkDiagnostic Radiological Services: $0–$300 copay
Out-of-network8b1: 50% coinsurance
Urgent & hospital care6 benefits
Urgent care
In-networkUrgently Needed Services: $50 copay
Out-of-networkNot separately reported
Emergency room
In-network$130 copay
Out-of-networkNot separately reported
Ground ambulance
In-network$300 copay
Out-of-network$300 copay
Air ambulance
In-network$300 copay
Out-of-network$300 copay
Outpatient hospital
In-networkOutpatient Hospital Services: 20% coinsurance + $0–$45 copay; Observation Services: $450 copay
Out-of-network9a1: 50% coinsurance; 9a2: 50% coinsurance
Outpatient surgery / ASC
In-networkAmbulatory Surgical Center (ASC) Services: $0–$395 copay
Out-of-network9b: 50% coinsurance
Recovery & therapy5 benefits
Home health
In-network$0 copay
Out-of-network50% coinsurance
Skilled nursing facility
In-networkSkilled nursing facility: Tier 1: $10 / day for days 1–20; $218 / day for days 21–51; $0 / day for days 52–100
Out-of-networkSkilled nursing facility: Tier 1: 50% coinsurance for days 1–100; 0% coinsurance
Cardiac & pulmonary rehabilitation
In-networkCardiac Rehabilitation Services: $40 copay; Intensive Cardiac Rehabilitation Services: $40 copay; Pulmonary Rehabilitation Services: $15 copay; SET for PAD Services: $25 copay; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable
Out-of-network3-1: 50% coinsurance; 3-2: 50% coinsurance; 3-3: 50% coinsurance; 3-4: 50% coinsurance
Occupational therapy
In-networkOccupational Therapy Services: $40 copay
Out-of-network7c: 50% coinsurance
Physical & speech therapy
In-networkPhysical Therapy and Speech-Language Pathology Services: $40 copay
Out-of-network7i: 50% coinsurance
Behavioral health2 benefits
Mental health services
In-networkPartial Hospitalization Program: $130 copay; Individual Sessions for Mental Health Specialty Services: $45 copay; Group Sessions for Mental Health Specialty Services: $45 copay; Individual Sessions for Psychiatric Services: $45 copay; Group Sessions for Psychiatric Services: $45 copay; Inpatient psychiatric hospital: Tier 1: $450 / day for days 1–5; $0 / day for days 6–90
Out-of-network5a: 50% coinsurance; 7e1: 50% coinsurance; 7e2: 50% coinsurance; 7h1: 50% coinsurance; 7h2: 50% coinsurance; Inpatient psychiatric hospital: Tier 1: 50% coinsurance for days 1–190; 0% coinsurance
Substance use treatment
In-networkIntensive Outpatient Program Services: $130 copay; Individual Sessions for Outpatient Substance Abuse: $45 copay; Group Sessions for Outpatient Substance Abuse: $45 copay
Out-of-network5b: 50% coinsurance; 9c1: 50% coinsurance; 9c2: 50% coinsurance
Specialty care2 benefits
Podiatry
In-networkPodiatry Services: $45 copay; 7f(NMC): Not applicable
Out-of-network7f: 50% coinsurance
Chiropractic
In-networkChiropractic Services: $15 copay
Out-of-network7b: 50% coinsurance
Supplemental benefits7 benefits
Dental
In-networkMedicare Dental Services: $45 copay; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 copay; Dental X-Rays: $0 copay; Other Diagnostic Dental Services: $0 copay; Prophylaxis (Cleaning): $0 copay; Fluoride Treatment: $0 copay; Other Preventive Dental Services: $0 copay; Restorative Services: 50% coinsurance; Endodontics: 50% coinsurance; Periodontics: 50% coinsurance; Prosthodontics, removable: 50% coinsurance; Oral and Maxillofacial Surgery: 50% coinsurance
Out-of-network16a: 50% coinsurance; 16b1: 50% coinsurance; 16b2: 50% coinsurance; 16b3: 50% coinsurance; 16b4: 50% coinsurance; 16b5: 50% coinsurance; 16b6: 50% coinsurance; 16c1: 50% coinsurance; 16c2: 50% coinsurance; 16c3: 50% coinsurance; 16c4: 50% coinsurance; 16c8: 50% coinsurance
Vision
In-networkEye Exams: $0 copay; Routine Eye Exams: $0 copay; Other Eye Exam Services: Not applicable; Eyewear: $0 copay; Eyeglasses (lenses and frames): Not applicable; Eyeglass lenses: $0 copay; Upgrades: Not applicable
Out-of-network17a: 50% coinsurance; 17a1: 50% coinsurance; 17b: 50% coinsurance; 17b1: $0 cost share; 17b3: 50% coinsurance; 17b4: $0 cost share
Hearing
In-networkHearing Exams: $45 copay; Routine Hearing Exams: $0 copay; Fitting/Evaluation for Hearing Aid: $0 copay; Prescription Hearing Aids (all types): $499–$999 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Out-of-network18a: 50% coinsurance; 18a1: 80% coinsurance; 18a2: 80% coinsurance; 18b1: 80% coinsurance
Transportation
Not applicableIn-network10b(NMC): Not applicable
Out-of-networkNot separately reported
Fitness & wellness
In-networkNot separately reported
Out-of-network14c4: 80% coinsurance
Over-the-counter allowance
Not applicableIn-networkOver-the-Counter (OTC) Items: Not applicable
Out-of-networkNot separately reported
Meals
Not applicableIn-networkMeal Benefit: Not applicable
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview
Premium & Part B giveback
$46.50 Part C premium / month · CMS reports no Part B premium reduction for this plan.
Maximum out-of-pocket (MOOP)
In-network$7,150
Combined in + out$10,100
Medical deductibles
In-networkNot reported
Out-of-networkNot reported
Annual health deductible
$0
Combined network deductible
Not separately reported
Part D premium
$15.50 / month
Network & referrals
Local PPO · Referrals: Not required · Out-of-network coverage: Yes
Prescription drugs5 tiers
Part D deductible
$700 / year
Drug tier 1
Standard retail: $0 copay · Preferred retail: $0 copay · 30-day supply
Drug tier 2
Standard retail: $2 copay · Preferred retail: $2 copay · 30-day supply
Drug tier 3
Standard retail: 23% coinsurance · Preferred retail: 23% coinsurance · 30-day supply
Drug tier 4
Standard retail: 32% coinsurance · Preferred retail: 32% coinsurance · 30-day supply
Drug tier 5
Standard retail: 25% coinsurance · Preferred retail: 25% coinsurance · 30-day supply
Using this plan
Understand H3817-011-002
Plain-language context built from this plan’s 2027 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.
Plan at a glance
A quick read on this plan
Regence MedAdvantage + Rx Primary (PPO) is a 2027 Local PPO offered by Regence BlueCross BlueShield of Oregon in Non-Metro. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals. Its listed inpatient copay stages total $2,250 across 5 charged days.
Common benefit costs
What you may pay
These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.
Routine care
- Primary care physician
- Primary Care Physician Services: $0 copay
- Specialist
- Physician Specialist Services: $45 copay
- Laboratory services
- Lab Services: $0–$35 copay
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- Diagnostic Procedures/Tests: $40 copay
- MRI, CT & PET imaging
- Diagnostic Radiological Services: $0–$300 copay
- Outpatient hospital
- Outpatient Hospital Services: 20% coinsurance + $0–$45 copay; Observation Services: $450 copay
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- $130 copay
- Listed inpatient stages
- $2,250 total
5 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.
Helpful context
Terms worth knowing
Maximum out-of-pocket (MOOP)
This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.
Part B premium reduction (“giveback”)
A giveback may reduce the amount you pay toward Medicare Part B; it is not usually paid to you as cash. The CMS record notes: CMS reports no Part B premium reduction for this plan.
Availability
Who can enroll
- Service area
- Non-Metro (OR)
- Plan type
- Local PPO
- Contract / plan
- H3817-011
- Coverage year
- 2027
Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.
Supplemental coverage
Extra benefits reported
Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.
DentalMedicare Dental Services: $45 copay; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 copay; Dental X-Rays: $0 copay; Other Diagnostic Dental Services: $0 copay; Prophylaxis (Cleaning): $0 copay; Fluoride Treatment: $0 copay; Other Preventive Dental Services: $0 copay; Restorative Services: 50% coinsurance; Endodontics: 50% coinsurance; Periodontics: 50% coinsurance; Prosthodontics, removable: 50% coinsurance; Oral and Maxillofacial Surgery: 50% coinsurance
VisionEye Exams: $0 copay; Routine Eye Exams: $0 copay; Other Eye Exam Services: Not applicable; Eyewear: $0 copay; Eyeglasses (lenses and frames): Not applicable; Eyeglass lenses: $0 copay; Upgrades: Not applicable
HearingHearing Exams: $45 copay; Routine Hearing Exams: $0 copay; Fitting/Evaluation for Hearing Aid: $0 copay; Prescription Hearing Aids (all types): $499–$999 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Fitness & wellnessNot separately reported
Plan-specific answers
Frequently asked questions
Where is H3817-011-002 available?
Regence MedAdvantage + Rx Primary (PPO) is listed for Non-Metro (OR). Enrollment generally requires Medicare eligibility and residence in the plan's service area.
What is the in-network maximum out-of-pocket limit for H3817-011-002?
The 2027 CMS record lists an in-network medical maximum out-of-pocket limit of $7,150. Prescription drug spending generally does not count toward this medical limit.
What is the monthly plan premium for H3817-011-002?
The listed consolidated Part C and Part D premium is $62 per month. This does not replace the standard Medicare Part B premium.
What does an emergency room visit cost on H3817-011-002?
The plan record lists $130 copay, waived when an admission meets the plan's stated timing rule.
Does H3817-011-002 report extra benefits?
Yes. CMS reports dental, vision, hearing, fitness & wellness. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2027
Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current official plan documents.
Plan context
Where H3817-011-002 fits
- Full CMS plan ID
H3817-011-002- Contract
H3817- Base plan code
H3817-011- Segment
002- Carrier
- Regence BlueCross BlueShield of Oregon
- Plan type
- Local PPO
- Service area
- Non-Metro (OR)
County/service-area foundation
CMS service-area entries
Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.
- Benton, OR
Exact county navigation
Counties with exact segment geography
These links are limited to named counties tied to this exact medical plan segment. Partial-county entries remain labeled for verification.
Show 1 county link
Oregon
About this code
What H3817-011-002 identifies
H3817-011-002 is a Contract Year 2027 Medicare plan segment code. Searches written as H3817-011, H3817 011, or the compact full CMS ID H3817011002 refer to this plan or its base plan code.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.