Regence Valiance (PPO) 2024 Benefit Details for Plan H1304-001-0 by Regence BlueShield Of Idaho
Regence Valiance is a 2024 PPO Medicare Advantage plan {with_without_pdp} prescription drug plan benefits (Part D).
This Regence BlueShield Of Idaho option offers the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may also include additional, valuable benefits not covered by Part A or Part B.
Plan Basics | |
---|---|
Plan ID: | H1304 001 0 |
Plan Type: | Local PPO |
Plan Year: | 2024 |
Premium: | $0.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $5,500/yr |
Part B Reduction: | $45.00/mo |
Drug Plan Benefit: | Not Included |
Rx Gap Coverage: | No |
Supplemental Benefits: | Dental, Vision, Hearing |
Availability: | See List |
Insured By: | Regence BlueShield Of Idaho |
Summary of Benefits |
---|
Health Plan Cost Sharing
This Regence BlueShield Of Idaho Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
---|---|
Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | $35 Copay |
Wellness programs (e.g., fitness, nursing hotline): | Web/Phone-based technologies |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $35 Copay |
Routine foot care: | Not Covered |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $20 Copay |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $120 Copay |
Urgent care: | $30 Copay |
Ground ambulance: | $275 Copay |
Inpatient hospital coverage: | $350.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital coverage: | $200 Copay Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 through 48 $0.00 per day for days 49 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $25 Copay |
Outpatient group therapy visit with a psychiatrist: | $25 Copay |
Inpatient hospital - psychiatric: | $350.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient group therapy visit: | $25 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $10 Copay Authorization Required |
Occupational therapy visit: | $10 Copay Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 Copay Authorization Required |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $300 Copay Authorization Required |
Lab services: | $0 Copay Authorization Required |
Outpatient x-rays: | $5 Copay Authorization Required |
Diagnostic tests and procedures: | $0 Copay Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Regence Valiance Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Regence BlueShield Of Idaho includes with this plan:
Supplemental Healthcare Service | Member Cost |
---|---|
Preventive Dental | Maximum dental benefit: | $1,500.00 Every year |
Oral exam (In-Network) | Covered |
Fluoride treatment (In-Network) | Covered |
Dental x-ray(s) (In-Network) | Covered |
Cleaning (In-Network) | Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Covered |
Extractions (In-Network) | Covered |
Endodontics (In-Network) | Covered |
Restorative services (In-Network) | Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay Limitations Apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay |
Vision | Maximum vision benefit: | Non Specified |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories based on a 5-star rating system. Here are the most recent CMS ratings for Regence Valiance.
CMS Measure | Star Rating |
---|---|
2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
It's not a 5-star PPO plan, but its quality of care exceeds most Medicare Advantage PPO plans in the areas served (see list below). Staying healthy is the best way to save money on health care, and Regence Valiance does a good job keeping its members in top health through preventive care, including screenings, tests, and vaccines. When it comes to helping members manage their chronic health conditions, this plan does an average job.
Medicare beneficiaries enrolled in this Regence BlueShield Of Idaho plan enjoy a good member experience. Complaints and changes in plan performance are one way we can measure quality, and this plan scores good at both. If you're concerned about how this health plan will treat you when you call for assistance, don't be. Members say it's good.
Healthy people in this plan get extra savings with the availability of dental, vision, and hearing benefits (see Health Plan Costs & Benefits for details).
No additional monthly premium with this plan is a potential savings opportunity for healthy individuals. This plan offers its members additional savings with a Part B premium reduction of $45.00 per month. We suggest carefully weighing this plan's maximum out-of-pocket limit, which is $5,500 per year. With a limit that high, Original Medicare alone would cost less for a 5-day hospital stay. This health plan does not have an annual deductible, making health care a little easier to budget.
Plan Availability
Regence Valiance (H1304-001-0) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H1304-012-2: Regence MedAdvantage + Rx Classic (PPO)
- H1304-004-0: Regence MedAdvantage + Rx Enhanced (PPO)
- H1304-011-2: Regence MedAdvantage + Rx Primary (PPO)
- H1304-012-1: Regence MedAdvantage + Rx Classic (PPO)
- H1304-011-1: Regence MedAdvantage + Rx Primary (PPO)
Contact Regence BlueShield Of Idaho
Plan Website: | http://www.regence.com/medicare |
---|---|
Formulary Information: | http://www.regence.com/medicare |
Pharmacy Information: | Regence BlueShield Of Idaho Pharmacy Page |
Prospective Members: | (888)369-3171 |
TTY Users: | (800)735-2900 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Regence BlueShield Of Idaho, http://www.regence.com/medicare, Last Accessed February 20, 2024
- Medicare.gov, "Your health plan options", Last Accessed February 20, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You Handbook", Last Accessed February 19, 2024
- Medicare.gov, "Your Medicare Coverage", Last Accessed April 11, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H1304-001-0 Plan Detail Page
The data on this Regence Valiance plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by Regence BlueShield Of Idaho to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from Regence BlueShield Of Idaho, at (888)369-3171, prior to enrollment.