2017 HumanaChoice R5826-091 (Regional PPO) R5826-091 By Humana Insurance Company

2017 Medicare Advantage HumanaChoice R5826-091 (Regional PPO)

HumanaChoice R5826-091 (Regional PPO) R5826-091 is a 2017 Medicare Advantage or Medicare Part-C plan by Humana Insurance Company available to residents in Texas. This plan includes additional Medicare prescription drug (Part-D) coverage. The HumanaChoice R5826-091 (Regional PPO) has a monthly premium of $42.00 and has a in-network Maximum Out-of-Pocket limit of $6,700 (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 $6,700 this can be a very nice safety net.

HumanaChoice R5826-091 (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.

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 R5826-091 (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 your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from Humana Insurance Company except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.


2017 Humana Insurance Company Medicare Advantage Plan Details

HumanaChoice R5826-091 (Regional PPO)
Provider:Humana Insurance Company
Type: Regional PPO
Monthly Premium C+D: $42.00
MOOP: $6,700

Ratings for HumanaChoice R5826-091 (Regional PPO) R5826

2017 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 R5826-091 (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 R5826-091 (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 R5826-091 (Regional PPO) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld
Call Center, TTY, Foreign Language

Part-C Premium

Humana Insurance Company plan charges a $17.00 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

HumanaChoice R5826-091 (Regional PPO) has a monthly drug premium of $25.00 and a $400.00 drug deductible. This Humana Insurance Company plan offers a $25.00 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 $25.00. 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 R5826-091 (Regional PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.20 for 75% low income subsidy $12.50 for 50% and $18.70 for 25%.

Part C Premium: $17.00
Part D (Drug) Premium: $25.00
Part D Supplemental Premium $0.00
Total Part D Premium: $25.00
Drug Deductible: $400.00
Tiers with No Deductible: 1
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $0.00
75% LIS Premium: $6.20
50% LIS Premium: $12.50
25% LIS Premium: $18.70
Initial Coverage Limit:$3700
Gap Coverage: Yes

Gap Coverage

In 2017 once you and your plan provider have spent $3700 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 40% for brand-name drugs and 51% on generic drugs unless your plan offers additional coverage. This Humana Insurance Company plan does offer additional coverage through the gap.

Coverage Area for HumanaChoice R5826-091 (Regional PPO)

(Click county to compare all available Advantage plans)

State: Texas
County:Anderson, Andrews, Angelina, Aransas,
Archer, Armstrong, Atascosa,
Austin, Bailey, Bandera,
Bastrop, Baylor, Bee,
Bell, Bexar, Blanco,
Borden, Bosque, Bowie,
Brazoria, Brazos, Brewster,
Briscoe, Brooks, Brown,
Burleson, Burnet, Caldwell,
Calhoun, Callahan, Cameron,
Camp, Carson, Cass,
Castro, Chambers, Cherokee,
Childress, Clay, Cochran,
Coke, Coleman, Collin,
Collingsworth, Colorado, Comal,
Comanche, Concho, Cooke,
Coryell, Cottle, Crane,
Crockett, Crosby, Culberson,
Dallam, Dallas, Dawson,
Deaf Smith, Delta, Denton,
DeWitt, Dickens, Dimmit,
Donley, Duval, Eastland,
Ector, Edwards, El Paso,
Ellis, Erath, Falls,
Fannin, Fayette, Fisher,
Floyd, Foard, Fort Bend,
Franklin, Freestone, Frio,
Gaines, Galveston, Garza,
Gillespie, Glasscock, Goliad,
Gonzales, Gray, Grayson,
Gregg, Grimes, Guadalupe,
Hale, Hall, Hamilton,
Hansford, Hardeman, Hardin,
Harris, Harrison, Hartley,
Haskell, Hays, Hemphill,
Henderson, Hidalgo, Hill,
Hockley, Hood, Hopkins,
Houston, Howard, Hudspeth,
Hunt, Hutchinson, Irion,
Jack, Jackson, Jasper,
Jeff Davis, Jefferson, Jim Hogg,
Jim Wells, Johnson, Jones,
Karnes, Kaufman, Kendall,
Kenedy, Kent, Kerr,
Kimble, King, Kinney,
Kleberg, Knox, La Salle,
Lamar, Lamb, Lampasas,
Lavaca, Lee, Leon,
Liberty, Limestone, Lipscomb,
Live Oak, Llano, Loving,
Lubbock, Lynn, Madison,
Marion, Martin, Mason,
Matagorda, Maverick, McCulloch,
McLennan, McMullen, Medina,
Menard, Midland, Milam,
Mills, Mitchell, Montague,
Montgomery, Moore, Morris,
Motley, Nacogdoches, Navarro,
Newton, Nolan, Nueces,
Ochiltree, Oldham, Orange,
Palo Pinto, Panola, Parker,
Parmer, Pecos, Polk,
Potter, Presidio, Rains,
Randall, Reagan, Real,
Red River, Reeves, Refugio,
Roberts, Robertson, Rockwall,
Runnels, Rusk, Sabine,
San Augustine, San Jacinto, San Patricio,
San Saba, Schleicher, Scurry,
Shackelford, Shelby, Sherman,
Smith, Somervell, Starr,
Stephens, Sterling, Stonewall,
Sutton, Swisher, Tarrant,
Taylor, Terrell, Terry,
Throckmorton, Titus, Tom Green,
Travis, Trinity, Tyler,
Upshur, Upton, Uvalde,
Val Verde, Van Zandt, Victoria,
Walker, Waller, Ward,
Washington, Webb, Wharton,
Wheeler, Wichita, Wilbarger,
Willacy, Williamson, Wilson,
Winkler, Wise, Wood,
Yoakum, Young, Zapata,

Source: CMS.

Data as of September 6, 2016.

Star Rating as of September 26, 2016.

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

Notes: Data are subject to change as contracts are finalized. For 2017, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit

Includes 2017 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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