2018 Medicare Advantage HumanaChoice R3392-002 (Regional PPO)

HumanaChoice R3392-002 (Regional PPO) R3392-002 is a 2018 Medicare Advantage or Medicare Part-C plan by Humana Insurance Company available to residents in South Carolina Georgia. This plan includes additional Medicare prescription drug (Part-D) coverage. The HumanaChoice R3392-002 (Regional PPO) has a monthly premium of $77.00 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 R3392-002 (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 R3392-002 (Regional PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and 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.

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2018 Humana Insurance Company Medicare Advantage Plan Details

Plan Services

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Health plan deductible

$0

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Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures	In-Network	$0-100
Diagnostic tests and procedures	Out-of-Network	$0-100 or 25%
Lab services	In-Network	$0-50
Lab services	Out-of-Network	$0-100
Diagnostic radiology services (e.g., MRI)	In-Network	$50-360
Diagnostic radiology services (e.g., MRI)	Out-of-Network	$50-360
Outpatient x-rays	In-Network	$20-100
Outpatient x-rays	Out-of-Network	$0-100

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Hearing

Hearing exam	In-Network	$50
Hearing exam	Out-of-Network	$50
Fitting/evaluation	In-Network	$0 copay
Fitting/evaluation	Out-of-Network	$0 copay
Hearing aids	In-Network	$699-999
Hearing aids	Out-of-Network	$699-999

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Preventive dental

Oral exam	In-Network	$0 copay
Oral exam	Out-of-Network	50%
Cleaning	In-Network	$0 copay
Cleaning	Out-of-Network	50%
Fluoride treatment		Not covered
Dental x-ray(s)	In-Network	$0 copay
Dental x-ray(s)	Out-of-Network	50%

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Comprehensive dental

Non-routine services		Not covered
Diagnostic services		Not covered
Restorative services	In-Network	0%
Restorative services	Out-of-Network	50%
Endodontics		Not covered
Periodontics		Not covered
Extractions	In-Network	0%
Extractions	Out-of-Network	50%
Prosthodontics, other oral/maxillofacial surgery, other services	In-Network	0%
Prosthodontics, other oral/maxillofacial surgery, other services	Out-of-Network	50%

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Vision

Routine eye exam	In-Network	$0 copay
Routine eye exam	Out-of-Network	$0 copay
Other		Not covered
Contact lenses		Not covered
Eyeglasses (frames and lenses)		Not covered
Eyeglass frames		Not covered
Eyeglass lenses		Not covered
Upgrades		Not covered

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Mental health services

	In-Network	$360 for days 1 through 4 $0 for days 5 through 90
	Out-of-Network	$360 for days 1 through 4 $0 for days 5 through 90
Outpatient group therapy visit with a psychiatrist	In-Network	$40
Outpatient group therapy visit with a psychiatrist	Out-of-Network	$40
Outpatient individual therapy visit with a psychiatrist	In-Network	$40
Outpatient individual therapy visit with a psychiatrist	Out-of-Network	$40
Outpatient group therapy visit	In-Network	$40
Outpatient group therapy visit	Out-of-Network	$40
Outpatient individual therapy visit	In-Network	$40
Outpatient individual therapy visit	Out-of-Network	$40

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Skilled Nursing Facility

	In-Network	$0 for days 1 through 20 $167 for days 21 through 100
	Out-of-Network	$0 for days 1 through 20 $167 for days 21 through 100

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Rehabilitation services

Occupational therapy visit	In-Network	$20-40
Occupational therapy visit	Out-of-Network	$20-40
Physical therapy and speech and language therapy visit	In-Network	$20-40
Physical therapy and speech and language therapy visit	Out-of-Network	$20-40

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Ambulance

	In-Network	$265 or 20%
	Out-of-Network	$265 or 20%

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Transportation

Not covered

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Other health plan deductibles?

	In-Network	No

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Foot care (podiatry services)

Foot exams and treatment	In-Network	$50
Foot exams and treatment	Out-of-Network	$50
Routine foot care		Not covered

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Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)	In-Network	20% per item
Durable medical equipment (e.g., wheelchairs, oxygen)	Out-of-Network	20% per item
Prosthetics (e.g., braces, artificial limbs)	In-Network	20% per item
Prosthetics (e.g., braces, artificial limbs)	Out-of-Network	20% per item
Diabetes supplies	In-Network	$0 or 10-20% per item
Diabetes supplies	Out-of-Network	20% per item

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Wellness programs (e.g., fitness, nursing hotline)

Covered

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Medicare Part B drugs

Chemotherapy	In-Network	20%
Chemotherapy	Out-of-Network	20%
Other Part B drugs	In-Network	20%
Other Part B drugs	Out-of-Network	20%

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$6,700 In and Out-of-network $6,700 In-network

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Optional supplemental benefits

No

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Inpatient hospital coverage

	In-Network	$360 for days 1 through 5 $0 for days 6 through 90 $0 for days 91 and beyond
	Out-of-Network	$360 for days 1 through 5 $0 for days 6 through 90

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Outpatient hospital coverage

	In-Network	$360 per visit
	Out-of-Network	$310-360 per visit

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Doctor visits

Primary	In-Network	$20 per visit
Primary	Out-of-Network	$20 per visit
Specialist	In-Network	$50 per visit
Specialist	Out-of-Network	$0-100 or 25% per visit

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Preventive care

	In-Network	$0 copay
	Out-of-Network	$0 copay

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Emergency care/Urgent care

Emergency		$80 per visit (always covered)
Urgent care		$20-50 per visit (always covered)

Ratings for HumanaChoice R3392-002 (Regional PPO) R3392

Member Experience with Health Plan

Member Complaints and Changes in HumanaChoice R3392-002 (Regional PPO) Plans Performance

Health Plan Customer Service Rating for HumanaChoice R3392-002 (Regional PPO)

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ratings For Member Complaints and Changes in the Drug Plans Performance

HumanaChoice R3392-002 (Regional PPO) Drug Plan Customer Service ratings

Part-C Premium

Humana Insurance Company plan charges a $42.20 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 R3392-002 (Regional PPO) has a monthly drug premium of $34.80 and a $340.00 drug deductible. This Humana Insurance Company plan offers a $34.80 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 $34.80. 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 R3392-002 (Regional PPO) medicare insurance offers a $10.80 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $16.80 for 75% low income subsidy $22.80 for 50% and $28.80 for 25%.

Gap Coverage

In 2018 once you and your plan provider have spent $3750 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 35% for brand-name drugs and 44% on generic drugs unless your plan offers additional coverage. This Humana Insurance Company plan does not offer additional coverage through the gap.

Coverage Area for HumanaChoice R3392-002 (Regional PPO)

(Click county to compare all available Advantage plans)

Source: CMS.

Data as of September 2, 2017.

Star Rating as of September 6, 2017.

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

Notes: Data are subject to change as contracts are finalized. For 2018, 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 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.