2014 HumanaChoice R5826-074 (Regional PPO) R5826-074 By Humana Insurance Company

HumanaChoice R5826-074 (Regional PPO) By Humana Insurance Company



HumanaChoice R5826-074 (Regional PPO) is a 2014 Medicare Advantage ("Part C" or "MA Plan") plan by Humana Insurance Company. This plan from Humana Insurance Company works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for HumanaChoice R5826-074 (Regional PPO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Humana Insurance Company and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



2014 Medicare Advantage Plan Details

Plan Name:
HumanaChoice R5826-074 (Regional PPO)
Plan ID:
R5826-074
Provider: Humana Insurance Company
Plan Year:2014
Plan Type: Regional PPO
Monthly Premium C+D: $-
MOOP: $5,900


Coverage Area for HumanaChoice R5826-074 (Regional PPO)

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The HumanaChoice R5826-074 (Regional PPO) R5826-074 is available to residents in Florida, and has a in-network Maximum Out-of-Pocket limit of $5,900 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in HumanaChoice R5826-074 (Regional PPO) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $5,900 This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.

HumanaChoice R5826-074 (Regional PPO) is a Regional 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.



Ratings for HumanaChoice R5826-074 (Regional PPO) R5826

2014 Overall Rating
Part C Summary Rating
Total Experience Rating
Complaints, Improvements
Total Customer Service Rating
Total Preventative Rating
Chronic And Long Term Care


Member Experience Rating for HumanaChoice R5826-074 (Regional PPO)

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints, Problems Getting Service and Improvements in Health Plans

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Access to Service
Performance Problems
Health Plan Quality Improvement


Customer Service Rating for HumanaChoice R5826-074 (Regional PPO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancel Screening
Cardiovascular Screening
Diabetes Care
Glaucoma Testing
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Ratings For Managing Chronic And Long Term Care

Total Rating
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Diabetes Care - Cholesterol
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions


Part-C Premium

Humana Insurance Company plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



Part-D Deductible and Premium

The HumanaChoice R5826-074 (Regional PPO) plan has a monthly drug premium of $0.00 and a $150.00 drug deductible. This Humana Insurance Company plan offers a $0.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Humana Insurance Company above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The HumanaChoice R5826-074 (Regional PPO) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.



Part C Premium: $0.00
Part D (Drug) Premium: $0.00
Part D Supplemental Premium $0.00
Total Part D Premium: $0.00
Drug Deductible: $150.00
Tiers with No Deductible: 1
Benchmark: not below the regional benchmark
Type of Medicare Health Plan: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $0.00
75% LIS Premium: $0.00
50% LIS Premium: $0.00
25% LIS Premium: $0.00
Inital Coverage Limit:$2850
Gap Coverage: Few Generics, Few Brands


Gap Coverage

In 2014 once you and your plan provider have spent $2,850 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be require to pay 47.5% of the plan's cost for covered brand-name prescription drugs and 72% of the cost for generic drugs unless your plan offers additional coverage. This Humana Insurance Company plan offers Few Generics, Few Brands through the gap. Few means 0% to 10% of the formulary drugs are covered if your are in the gap and must also be greather then 15 "brand" products covered through the gap.



Source: CMS.

Plans as of September 3, 2013.

Star Rating as of September 27, 2013.

For More Information on Ratings Please See the CMS Tech Notes Here.

Plans are subject to change as contracts are finalized.

Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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