2018 HumanaChoice R5361-001 (Regional PPO) R5361-001 By Humana Insurance Company

2018 Medicare Advantage HumanaChoice R5361-001 (Regional PPO)

HumanaChoice R5361-001 (Regional PPO) R5361-001 is a 2018 Medicare Advantage or Medicare Part-C plan by Humana Insurance Company available to residents in Illinois Wisconsin. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The HumanaChoice R5361-001 (Regional PPO) has a monthly premium of $0.00 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 R5361-001 (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 R5361-001 (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.


2018 Humana Insurance Company Medicare Advantage Plan Details

HumanaChoice R5361-001 (Regional PPO)
Provider:Humana Insurance Company
Type: Regional PPO *
Monthly Premium C+D: $0.00
MOOP: $6,700

Plan Services

Health plan deductible

$200 annual deductible

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures In-Network $0-95
Diagnostic tests and procedures Out-of-Network 50%
Lab services In-Network $0-40
Lab services Out-of-Network 50%
Diagnostic radiology services (e.g., MRI) In-Network $15-295
Diagnostic radiology services (e.g., MRI) Out-of-Network 50%
Outpatient x-rays In-Network $15-95
Outpatient x-rays Out-of-Network 50%


Hearing exam In-Network $45
Hearing exam Out-of-Network 50%
Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered

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%

Comprehensive dental

Non-routine services Not covered
Diagnostic services Not covered
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Extractions Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered


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

Mental health services

In-Network $260 for days 1 through 6
$0 for days 7 through 90
Out-of-Network 50% per stay
Outpatient group therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit with a psychiatrist Out-of-Network 50%
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient individual therapy visit with a psychiatrist Out-of-Network 50%
Outpatient group therapy visit In-Network $40
Outpatient group therapy visit Out-of-Network 50%
Outpatient individual therapy visit In-Network $40
Outpatient individual therapy visit Out-of-Network 50%

Skilled Nursing Facility

In-Network $0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network 50% per stay

Rehabilitation services

Occupational therapy visit In-Network $40
Occupational therapy visit Out-of-Network 50%
Physical therapy and speech and language therapy visit In-Network $40
Physical therapy and speech and language therapy visit Out-of-Network 50%


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


Not covered

Other health plan deductibles?

In-Network No

Foot care (podiatry services)

Foot exams and treatment In-Network $45
Foot exams and treatment Out-of-Network 50%
Routine foot care Not covered

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 10% per item
Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 15% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 50% per item
Diabetes supplies In-Network $0 or 10-20% per item
Diabetes supplies Out-of-Network 50% per item

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


Medicare Part B drugs

Chemotherapy In-Network 19%
Chemotherapy Out-of-Network 50%
Other Part B drugs In-Network 19%
Other Part B drugs Out-of-Network 50%

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

$10,000 In and Out-of-network
$6,700 In-network

Optional supplemental benefits


Inpatient hospital coverage

In-Network $295 for days 1 through 6
$0 for days 7 through 90
$0 for days 91 and beyond
Out-of-Network 50% per stay

Outpatient hospital coverage

In-Network $295 per visit
Out-of-Network 50% per visit

Doctor visits

Primary In-Network $15 per visit
Primary Out-of-Network 50% per visit
Specialist In-Network $45 per visit
Specialist Out-of-Network 50% per visit

Preventive care

In-Network $0 copay
Out-of-Network $0 or 50%

Emergency care/Urgent care

Emergency $80 per visit (always covered)
Urgent care $15-45 or 50% per visit (always covered)

Ratings for HumanaChoice R5361-001 (Regional PPO) R5361

2018 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 R5361-001 (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 R5361-001 (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 Cancer 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
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 R5361-001 (Regional PPO) Drug Plan Customer Service ratings

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

Coverage Area for HumanaChoice R5361-001 (Regional PPO)

(Click county to compare all available plans)

County:Adams, Adams, Alexander, Ashland,
Barron, Bayfield, Bond,
Boone, Brown, Brown,
Buffalo, Bureau, Burnett,
Calhoun, Calumet, Carroll,
Cass, Champaign, Chippewa,
Christian, Clark, Clark,
Clay, Clinton, Coles,
Columbia, Cook, Crawford,
Crawford, Cumberland, Dane,
De Witt, DeKalb, Dodge,
Door, Douglas, Douglas,
Dunn, DuPage, Eau Claire,
Edgar, Edwards, Effingham,
Fayette, Florence, Fond du Lac,
Ford, Forest, Franklin,
Fulton, Gallatin, Grant,
Green, Green Lake, Greene,
Grundy, Hamilton, Hancock,
Hardin, Henderson, Henry,
Iowa, Iron, Iroquois,
Jackson, Jackson, Jasper,
Jefferson, Jefferson, Jersey,
Jo Daviess, Johnson, Juneau,
Kane, Kankakee, Kendall,
Kenosha, Kewaunee, Knox,
La Crosse, La Salle, Lafayette,
Lake, Langlade, Lawrence,
Lee, Lincoln, Livingston,
Logan, Macon, Macoupin,
Madison, Manitowoc, Marathon,
Marinette, Marion, Marquette,
Marshall, Mason, Massac,
McDonough, McHenry, McLean,
Menard, Menominee, Mercer,
Milwaukee, Monroe, Monroe,
Montgomery, Morgan, Moultrie,
Oconto, Ogle, Oneida,
Outagamie, Ozaukee, Peoria,
Pepin, Perry, Piatt,
Pierce, Pike, Polk,
Pope, Portage, Price,
Pulaski, Putnam, Racine,
Randolph, Richland, Richland,
Rock, Rock Island, Rusk,
Saline, Sangamon, Sauk,
Sawyer, Schuyler, Scott,
Shawano, Sheboygan, Shelby,
St. Clair, St. Croix, Stark,
Stephenson, Taylor, Tazewell,
Trempealeau, Union, Vermilion,
Vernon, Vilas, Wabash,
Walworth, Warren, Washburn,
Washington, Washington, Waukesha,
Waupaca, Waushara, Wayne,
White, Whiteside, Will,
Williamson, Winnebago, Winnebago,
Wood, Woodford,

Source: CMS.

Data as of September 5, 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.

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