2016 Medicare Advantage HumanaChoice R5826-065 (Regional PPO)
HumanaChoice R5826-065 (Regional PPO) R5826-065 is a 2016 Medicare Advantage or Medicare Part-C plan by Humana Insurance Company available to residents in Tennessee Alabama. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The HumanaChoice R5826-065 (Regional PPO) has a monthly premium of $0.00 and has a in-network Maximum Out-of-Pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket $3,400 this can be a very nice safety net.
HumanaChoice R5826-065 (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.
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 R5826-065 (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.
2016 Humana Insurance Company Medicare Advantage Plan Details
| Plan Name: | HumanaChoice R5826-065 (Regional PPO) |
|---|---|
| Plan ID: | R5826-065 |
| Provider: | Humana Insurance Company |
| Parent: | Humana Inc. |
| Plan Year: | 2016 |
| Plan Type: | Regional PPO * |
| Monthly Premium C+D: | $0.00 |
| MOOP: | $3,400 |
Plan Services
Monthly premium deductible and limits on how much you pay for covered services
$0.00 per month. In addition you must keep paying your Medicare Part B premium. This plan has deductibles for some hospital and medical services. $500 per year for out-of-network services. Yes. Like all Medicare health plans our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care. Your yearly limit(s) in this plan:
- $3 400 for services you receive from in-network providers.
- $5 100 for services you receive from any provider. Your limit for services received from in-network providers will count toward this limit.
Doctor's office visits
Primary care physician visit:
- In-network: $10 copay
- Out-of-network: 30% of the cost
- In-network: $10-30 copay depending on the service
- Out-of-network: 30% of the cost
Durable medical equipment (wheelchairs oxygen etc.)
- In-network: 15% of the cost
- Out-of-network: 20% of the cost
Emergency care
$75 copay If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for emergency care. See the "Inpatient Hospital Care" section for other costs.
Foot care (podiatry services)
Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:
- In-network: $30 copay
- Out-of-network: 30% of the cost
Hearing services
Exam to diagnose and treat hearing and balance issues:
- In-network: $30 copay
- Out-of-network: 30% of the cost
Home health care
- In-network: You pay nothing
- Out-of-network: 30% of the cost
Mental health care
Inpatient visit: Our plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital. Our plan covers 90 days for an inpatient hospital stay. Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days you can use these extra days. But once you have used up these extra 60 days your inpatient hospital coverage will be limited to 90 days.
- In-network:
- $550 copay per stay
- Out-of-network:
- 30% of the cost per stay
- In-network: $30 copay
- Out-of-network: 30% of the cost
- In-network: $30 copay
- Out-of-network: 30% of the cost
Outpatient rehabilitation
Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks):
- In-network: $30-50 copay depending on the service
- Out-of-network: 30% of the cost
- In-network: $30-40 copay depending on the service
- Out-of-network: 30% of the cost
- In-network: $30-40 copay depending on the service
- Out-of-network: 30% of the cost
Outpatient substance abuse
Group therapy visit:
- In-network: $30-50 copay depending on the service
- Out-of-network: 30% of the cost
- In-network: $30-50 copay depending on the service
- Out-of-network: 30% of the cost
Outpatient surgery
Ambulatory surgical center:
- In-network: $75 copay
- Out-of-network: 30% of the cost
- In-network: $95 copay
- Out-of-network: 30% of the cost
Acupuncture
Not covered
Over-the-counter items
Please visit our website to see our list of covered over-the-counter items.
Prosthetic devices (braces artificial limbs etc.)
Prosthetic devices:
- In-network: 20% of the cost
- Out-of-network: 30% of the cost
- In-network: 20% of the cost
- Out-of-network: 30% of the cost
Renal dialysis
- In-network: 20% of the cost
- Out-of-network: 20% of the cost
Transportation
Not covered
Urgently needed services
$10-30 copay or 30% of the cost (up to $65) depending on the service
Vision services
Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):
- In-network: $0-30 copay depending on the service
- Out-of-network: 30% of the cost
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: You pay nothing
- Out-of-network: You pay nothing
Preventive care
- In-network: You pay nothing
- Out-of-network: 0-30% of the cost depending on the service
- Abdominal aortic aneurysm screening
- Alcohol misuse counseling
- Bone mass measurement
- Breast cancer screening (mammogram)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular screenings
- Cervical and vaginal cancer screening
- Colorectal cancer screenings (Colonoscopy Fecal occult blood test Flexible sigmoidoscopy)
- Depression screening
- Diabetes screenings
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
- "Welcome to Medicare" preventive visit (one-time)
- Yearly "Wellness" visit
Hospice
You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care.
Inpatient hospital care
Our plan covers an unlimited number of days for an inpatient hospital stay.
- In-network:
- $550 copay per stay
- You pay nothing per day for days 91 and beyond
- Out-of-network:
- 30% of the cost per stay
Inpatient mental health care
For inpatient mental health care see the "Mental Health Care" section.
Skilled Nursing Facility (SNF)
Our plan covers up to 100 days in a SNF.
- In-network:
- You pay nothing per day for days 1 through 7
- $40 copay per day for days 8 through 20
- $100 copay per day for days 21 through 100
- Out-of-network:
- 30% of the cost per stay
Outpatient prescription drugs
For Part B drugs such as chemotherapy drugs1:
- In-network: 20% of the cost
- Out-of-network: 20-30% of the cost depending on the drug
- In-network: 20% of the cost
- Out-of-network: 20-30% of the cost depending on the drug
Ambulance
- In-network: $300 copay
- Out-of-network: $300 copay
Chiropractic care
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):
- In-network: $20 copay
- Out-of-network: 30% of the cost
Dental services
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):Cleaning (for up to 1 every year): Dental x-ray(s) (for up to 1 every year): Oral exam (for up to 1 every year):
- In-network: $30 copay
- Out-of-network: 30% of the cost
- In-network: You pay nothing
- Out-of-network: 50% of the cost
- In-network: You pay nothing
- Out-of-network: 50% of the cost
- In-network: You pay nothing
- Out-of-network: 50% of the cost
Diabetes supplies and services
Diabetes monitoring supplies:
- In-network: 0-20% of the cost depending on the supply
- Out-of-network: 30% of the cost
- In-network: You pay nothing
- Out-of-network: 30% of the cost
- In-network: $10 copay
- Out-of-network: 30% of the cost
Diagnostic tests lab and radiology services and x-rays (Costs for these services may be different if received in an outpatient surgery setting)
Diagnostic radiology services (such as MRIs CT scans):
- In-network: $30-150 copay depending on the service
- Out-of-network: 30% of the cost
- In-network: $0-50 copay depending on the service
- Out-of-network: 30% of the cost
- In-network: $0-50 copay depending on the service
- Out-of-network: 30% of the cost
- In-network: $10-50 copay depending on the service
- Out-of-network: 30% of the cost
- In-network: $30-50 copay depending on the service
- Out-of-network: 30% of the cost
Coverage Area for HumanaChoice R5826-065 (Regional PPO)
(Click county to compare all available plans)
Ratings for HumanaChoice R5826-065 (Regional PPO) R5826
| 2016 Overall Rating | ||
|---|---|---|
| Part C Summary Rating | ||
| Part D Summary 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 |
Member Experience with Health Plan
| Total Experience Rating | ||
|---|---|---|
| Getting Needed Care | ||
| Timely Care and Appointments | ||
| Customer Service | ||
| Health Care Quality | ||
| Rating of Health Plan | ||
| Care Coordination |
Member Complaints and Changes in HumanaChoice R5826-065 (Regional PPO) Plans Performance
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Beneficiary Access | ||
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for HumanaChoice R5826-065 (Regional PPO)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center, TTY, Foreign Language |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | ||
|---|---|---|
| Breast Cancer Screening | ||
| Colorectal Cancel Screening | ||
| Annual Flu Vaccine | ||
| Improving Physical | ||
| Improving Mental Health | ||
| Monitoring Physical Activity | ||
| Adult BMI Assessment |
Managing Chronic And Long Term Care for Older Adults
| Total Rating | ||
|---|---|---|
| SNP Care Management | ||
| Medication Review | ||
| Functional Status Assessment | ||
| Pain Screening | ||
| Osteoporosis Management | ||
| Diabetes Care - Eye Exam | ||
| Diabetes Care - Kidney Disease | ||
| Diabetes Care - Blood Sugar | ||
| Controlling Blood Pressure | ||
| Rheumatoid Arthritis | ||
| Improving Bladder Control | ||
| Reducing Risk of Falling | ||
| Plan - Cause Readmissions |
Member Experience with the Drug Plan
| Total Rating | ||
|---|---|---|
| Rating of Drug Plan | ||
| Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
| Total Rating | ||
|---|---|---|
| MPF Price Accuracy | ||
| High Risk Medication | ||
| Drug Adherence for Diabetes Medications | ||
| Drug Adherence for Hypertension (RAS antagonists) | ||
| Drug Adherence for Cholesterol (Statins) | ||
| MTM Program Completion Rate for CMR |
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating | ||
|---|---|---|
| Complaints about the Drug Plan | ||
| Members Choosing to Leave the Plan | ||
| Beneficiary Access | ||
| Drug Plan Quality Improvement |
HumanaChoice R5826-065 (Regional PPO) Drug Plan Customer Service ratings
| Total Rating | ||
|---|---|---|
| Appeals Auto Forward | ||
| Appeals Upheld | ||
| Call Center, TTY, Foreign Language |
Source: CMS.
Plans as of September 9, 2015
Star Rating as of September 30, 2015.
For More Information on Ratings Please See the CMS Tech Notes Here.
Notes: Data are subject to change as contracts are finalized. For 2016, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit
Includes 2016 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.