Regence is a health insurance company offering products to those who live in Oregon, Idaho, and Washington. They offer Medicare Advantage for those who are over 65 and have some great benefits. Today I will provide a comprehensive review of Regence Medicare Advantage.
- Regence Medicare Advantage overview
- Types of Medicare Advantage plans offered by Regence
- Cost of Regence Medicare Advantage
- Plan Comparison: Regence HMO vs Regence PPO
- A summary: the Regence Medicare Advantage plan I would pick
What is Regence Medicare Advantage?
Medicare Advantage is a replacement to traditional Medicare. It combines parts A and B of traditional Medicare and offers several additional benefits. One thing you will notice with Medicare Advantage is that most plans look and feel like your employer-sponsored health insurance.
These plans are offered by private insurance companies, which is how they can offer great additional benefits. The insurance companies are paid by Medicare to offer these plans. Regence is a Blue Cross Blue Shield entity that serves the Pacific Northwest with many Medicare Advantage plan options.
I believe Medicare Advantage will continue to grow as the baby boomer generation enters deeper into retirement. Regence offers several types of plans in the pacific northwest, of which I will review below.
Why I love Medicare Advantage
Medicare Advantage offers benefits found by neither traditional Medicare or supplemental Medicare (Medigap). The benefits tend to be fun extras like fitness memberships, alternative care, telehealth, and newsletters.
The best benefit offered by Medicare Advantage is an out-of-pocket maximum. An out-of-pocket max protects you from exorbitant costs by limiting the amount of money you can spend on health in a given plan year.
Out-of-pocket maximums are not found in traditional Medicare and are rare in supplemental Medicare plans.
The other reason I love Medicare Advantage so much is that it often comes at $0 additional cost per month. Yep – all those great benefits, better coverage, and the out-of-pocket maximum all costs $0 more per month for many plans.
To learn more about Medicare Advantage and the changes coming in 2022, check out my book on Amazon:
Medicare Advantage vs Traditional Medicare in 2021
I just explained why I love Medicare Advantage. It has robust benefits, an out-of-pocket maximum, and often comes at little to no extra cost.
In contrast, traditional Medicare has two basic things: hospital coverage (Part A) and outpatient / physician coverage (Part B). Medicare Part A is the most elementary form of Medicare and will provide coverage for hospital stays and other hospital-based costs after you pay your deductible. Medicare Part B costs extra (!!) and can vary depending on your income. Ultimately, you can pay a lot of money to get very minimal health coverage.
I always caution people to learn the basics of health insurance before they embark on picking a plan. I cover all of that in my book (see above).
Let’s dig into what exactly Regence Medicare Advantage is offering and a comparison of two plans.
What types of Medicare Advantage plans does Regence offer?
Regence Medicare Advantage comes in a few forms: health maintenance organizations (HMOs) and preferred provider organizations (PPOs). They even offer plans for veterans in select parts of the pacific northwest. Check to see which plans are available to you by entering your zip code into their plan selector.
Just like other insurance companies, Regence offers an HMO plan. HMO plans are defined by having a relatively narrow network of providers that you can visit. This means that you will have to see doctors and other healthcare providers from a very specific list. If you visit providers outside of their network, you will incur steeper out-of-pocket payments.
While HMOs are one of the most restrictive types of health insurance plans, they come with a lower price than PPOs. They often offer the same additional benefits that PPOs offer and still provide excellent coverage.
Many people choose a PPO over an HMO because HMOs scare them. They are a lower cost, which reduces their credibility in the eyes of the consumer. Don’t be fooled! HMOs offer very similar coverage, if not the exact same, for Medicare Advantage plans.
The key difference in how HMOs work is in their gatekeeper requirement. HMOs often require your primary care provider (PCP) to be a “gatekeeper” to your care. This means that any time you want to see a cardiologist, orthopedist, or other specialist, you will have to get approval from your primary care doctor.
The requirement for a gatekeeper is not a bad thing. While it can sometimes slow things down, going through a gatekeeper can save you serious money. The gatekeeper primary care provider will help you find in-network providers, tell you if you really NEED to go to the specialist, and will work to coordinate all of your care.
Health insurance companies like Regence like this gatekeeper relationship because it improves outcomes, ensures that care is being delivered the right way, and can lower the cost of care for them (and you).
A word of caution
While HMOs are great coverage, you will want to make sure your doctors are in-network. Check out the resource center in the details of each of these plans to make sure your favorite doctors are included, otherwise you could face huge out-of-pocket costs.
If you do not have a primary care doctor or are not particularly attached to your current provider, no worries – proceed with the HMO!
PPOs are similar to HMOs in that they require you to visit specific providers. The list of providers in a PPO tends to be much larger than an HMO. PPOs will often provide more cost sharing for out-of-network providers, which is great if you get sick on vacation or spend time as a seasonal visitor of another location (snowbirds).
PPOs are a very traditional form of health insurance that basically boils down to higher monthly costs with lower costs if you actually get sick. This is much different than a high-deductible health plan, which has very little monthly costs but high costs for those that need medical services.
Regence Explains why they offer the best plans in this video.
Regence Medicare Advantage costs
Costs for Medicare Advantage plans can differ drastically. Many plans can cost $0 additional each month, while others can cost $50 or more per month. As a reminder, Medicare Advantage monthly costs are IN ADDITION TO your monthly part B premium, which is $148.50 at its base form in 2021.
Things that influence a Medicare Advantage plan cost include prescription drug coverage, PPO vs HMO, comprehensive dental coverage, and the availability of plans in your area.
Plan Comparison: Regence Medicare Advantage HMO vs PPO
Regence’s website has a great tool for comparing plans they offer. I chose a zip code in Portland, OR to find the plans offered. For the purposes of this exercise, I am comparing their Regence BlueAdvantage HMO to the Regence MedAdvantage + Rx Primary (PPO). Let’s take a look:
Monthly Premium for Regence Medicare Advantage
The monthly plan premium for both of these plans is $0. That’s right – purchasing this plan will cost you an additional $0 per month in Medicare costs. Both win in this category. One thing to keep in mind is that this isn’t $0 per month its $0 ADDITIONAL dollars per month.
Medicare Part B costs money. Yep, I know you have been paying for Medicare for many, many years (at least 10) and think that you are going to get great benefits for free. Nope – that is Medicare Part A only.
The base monthly premium in 2021 for Medicare Part B is $148.50. For those still earning a higher income, make sure to check out the Medicare income limits that change your monthly premium. You can find a link to my post about this here.
Star ratings help folks navigate the “quality” of a Medicare Advantage plan. Again, both have a 4.5/5 star rating, which is very high quality. Both win again!
Star ratings are a stringent system applied by the Center for Medicare and Medicaid Services to rate several quality measures. These ratings take into account the below metrics:
- Staying healthy: screenings, tests, and vaccines
- Managing chronic conditions
- Member complaints
- Health plan customer service
- Plan responsiveness and care
While 4.5 stars is great, keep in mind that the majority of Medicare Advantage plans received 4 or more stars. Either the bar is really low or these plans are all great (I think the latter).
This is an important one. These plans typically offer an in-network and out-of-network out of pocket max. If you stay in-network, the HMO plan has an out-of-pocket max of $5,500 whereas the PPO plan has one that is $6,200.
The HMO wins this category.
Out-of-pocket maximums are super important features of a health insurance plan. This is the maximum amount you will have to pay out of pocket in a given plan year, regardless of expenses incurred. For those that get a serious injury or illness, you can reach this pretty quickly.
Traditional Medicare and even many supplemental Medicare plans DO NOT have an out of pocket maximum and therefore do not have a cap on how much you can spend. I highly recommend Medicare Advantage for this reason.
Prescription drug coverage
As a huge benefit to purchasing a Medicare Advantage plan, most come with Medicare Part D included. If you have traditional Medicare, this must be purchased separately for an additional cost.
Both of these plans offer prescription drug coverage. The HMO offers a $200 deductible and lower copays for almost all categories of drugs. A deductible is the amount that you have to pay before the plan starts paying for things. Categories of drugs include Tiers 1-5, with Tier 1 being preferred generic drugs (cheaper) and Tier 5, which includes specialty drugs.
The PPO offers a $250 deductible and higher copays for their drugs.
The HMO wins this category as well.
Copays for Medical Services
See below table for a comparison of copays associated with various services. As you can see, the HMO is much more affordable compared to the PPO.
Copay comparison for Regence Medicare Advantage HMO and PPO.
Some additional benefits offered by both of these plans include:
- Basic vision insurance
- Basic dental insurance
- Hearing aid coverage
- Alternative care (chiropractic, etc)
- Fitness Membership
- A quarterly stipend for over-the-counter drugs
- Additional comprehensive dental coverage for $24/month
It is a tie! Both offer awesome extra benefits.
As a reminder, Medicare does not cover these benefits. This means you would have to pay out of pocket for things like basic vision and dental. The additional cost (if any) of a Medicare Advantage plan from Regence instantly has a return on investment if you want a teeth cleaning or eye exam.
A summary: Which Regence Medicare Advantage plan is best in 2021?
I have seen enough! The HMO and the PPO have both been thoroughly examined and there can only be one winner.
The HMO offers a more restrictive network but lower costs. If you are agnostic to which providers you are seeing, the HMO is absolutely the way to go.
The PPO offers a wider network of providers, but higher costs at almost every interaction. If you want to keep your current doctor, the PPO might be worth it. However, the PPO does have increased costs and copays for some basic features of health insurance. This is the price you pay for seeing your favorite group of doctors.
That being said – the particular HMO offered here by Regence might have your favorite group of doctors in-network for a lower cost!
The bottom line is that both offer fantastic coverage. The HMO will save you money on health expenses, there are no bones about it. But the PPO will only be marginally more expensive and you can keep the doctor you love.
If it were up to me, I would go with the HMO (but I am a cheapskate). Regence’s PPO plan is also a great plan and will allow for greater flexibility.