2018 Medicare Advantage HumanaChoice R7315-001 (Regional PPO)
HumanaChoice R7315-001 (Regional PPO) R7315-001 is a 2018 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 R7315-001 (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 R7315-001 (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 R7315-001 (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
| Name: | HumanaChoice R7315-001 (Regional PPO) |
|---|
| ID: | R7315-001 |
|---|
| Provider: | Humana Insurance Company |
|---|
| Year: | 2018 |
|---|
| Type: | Regional PPO * |
|---|
| Monthly Premium C+D: | $0.00 |
|---|
| MOOP: | $3,400 |
|---|
Plan Services
Health plan deductible
Diagnostic procedures/lab services/imaging
| Diagnostic tests and procedures |
In-Network |
$0-50 |
| Diagnostic tests and procedures |
Out-of-Network |
30% |
| Lab services |
In-Network |
$0-40 |
| Lab services |
Out-of-Network |
30% |
| Diagnostic radiology services (e.g., MRI) |
In-Network |
$30-150 |
| Diagnostic radiology services (e.g., MRI) |
Out-of-Network |
30% |
| Outpatient x-rays |
In-Network |
$10-50 |
| Outpatient x-rays |
Out-of-Network |
30% |
Hearing
| Hearing exam |
In-Network |
$30 |
| Hearing exam |
Out-of-Network |
30% |
| 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 |
In-Network |
0% |
| Restorative services |
Out-of-Network |
50% |
| Endodontics |
|
Not covered |
| Periodontics |
|
Not covered |
| Extractions |
|
Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services |
|
Not covered |
Vision
| Routine eye exam |
In-Network |
$0 copay |
| Routine eye exam |
Out-of-Network |
$0 copay |
| Other |
|
Not covered |
| Contact lenses |
In-Network |
$0 copay |
| Contact lenses |
Out-of-Network |
$0 copay |
| Eyeglasses (frames and lenses) |
In-Network |
$0 copay |
| Eyeglasses (frames and lenses) |
Out-of-Network |
$0 copay |
| Eyeglass frames |
|
Not covered |
| Eyeglass lenses |
|
Not covered |
| Upgrades |
|
Not covered |
Mental health services
| |
In-Network |
$550 per stay |
| |
Out-of-Network |
30% per stay |
| Outpatient group therapy visit with a psychiatrist |
In-Network |
$30 |
| Outpatient group therapy visit with a psychiatrist |
Out-of-Network |
30% |
| Outpatient individual therapy visit with a psychiatrist |
In-Network |
$30 |
| Outpatient individual therapy visit with a psychiatrist |
Out-of-Network |
30% |
| Outpatient group therapy visit |
In-Network |
$30 |
| Outpatient group therapy visit |
Out-of-Network |
30% |
| Outpatient individual therapy visit |
In-Network |
$30 |
| Outpatient individual therapy visit |
Out-of-Network |
30% |
Skilled Nursing Facility
| |
In-Network |
$0 for days 1 through 7
$20 for days 8 through 20
$167 for days 21 through 100 |
| |
Out-of-Network |
30% per stay |
Rehabilitation services
| Occupational therapy visit |
In-Network |
$30-40 |
| Occupational therapy visit |
Out-of-Network |
30% |
| Physical therapy and speech and language therapy visit |
In-Network |
$30-40 |
| Physical therapy and speech and language therapy visit |
Out-of-Network |
30% |
Ambulance
| |
In-Network |
$265 or 20% |
| |
Out-of-Network |
$265 or 20% |
Transportation
Other health plan deductibles?
Foot care (podiatry services)
| Foot exams and treatment |
In-Network |
$30 |
| Foot exams and treatment |
Out-of-Network |
30% |
| Routine foot care |
|
Not covered |
Medical equipment/supplies
| Durable medical equipment (e.g., wheelchairs, oxygen) |
In-Network |
15% 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 |
30% per item |
| Diabetes supplies |
In-Network |
$0 or 10-20% per item |
| Diabetes supplies |
Out-of-Network |
30% per item |
Wellness programs (e.g., fitness, nursing hotline)
Medicare Part B drugs
| Chemotherapy |
In-Network |
20% |
| Chemotherapy |
Out-of-Network |
20-30% |
| Other Part B drugs |
In-Network |
20% |
| Other Part B drugs |
Out-of-Network |
20-30% |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$5,100 In and Out-of-network
$3,400 In-network |
|
|
Optional supplemental benefits
Inpatient hospital coverage
| |
In-Network |
$550 per stay |
| |
Out-of-Network |
30% per stay |
Outpatient hospital coverage
| |
In-Network |
$95 per visit |
| |
Out-of-Network |
30% per visit |
Doctor visits
| Primary |
In-Network |
$10 per visit |
| Primary |
Out-of-Network |
30% per visit |
| Specialist |
In-Network |
$30 per visit |
| Specialist |
Out-of-Network |
30% per visit |
Preventive care
| |
In-Network |
$0 copay |
| |
Out-of-Network |
$0 or 30% |
Emergency care/Urgent care
| Emergency |
|
$80 per visit (always covered) |
| Urgent care |
|
$10-30 or 30% per visit (always covered) |
Ratings for HumanaChoice R7315-001 (Regional PPO) R7315
| 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 R7315-001 (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 R7315-001 (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 R7315-001 (Regional PPO) Drug Plan Customer Service ratings
| Total Rating | | |
|---|
| Appeals Auto Forward | | |
|---|
| Appeals Upheld | | |
|---|
| Call Center, TTY, Foreign Language | | |
|---|
Coverage Area for HumanaChoice R7315-001 (Regional PPO)
(Click county to compare all available plans)
| State: | Tennessee
Alabama
| County: | Anderson, Autauga, Baldwin, Barbour,
Bedford, Benton, Bibb,
Bledsoe, Blount, Blount,
Bradley, Bullock, Butler,
Calhoun, Campbell, Cannon,
Carroll, Carter, Chambers,
Cheatham, Cherokee, Chester,
Chilton, Choctaw, Claiborne,
Clarke, Clay, Clay,
Cleburne, Cocke, Coffee,
Coffee, Colbert, Conecuh,
Coosa, Covington, Crenshaw,
Crockett, Cullman, Cumberland,
Dale, Dallas, Davidson,
Decatur, DeKalb, DeKalb,
Dickson, Dyer, Elmore,
Escambia, Etowah, Fayette,
Fayette, Fentress, Franklin,
Franklin, Geneva, Gibson,
Giles, Grainger, Greene,
Greene, Grundy, Hale,
Hamblen, Hamilton, Hancock,
Hardeman, Hardin, Hawkins,
Haywood, Henderson, Henry,
Henry, Hickman, Houston,
Houston, Humphreys, Jackson,
Jackson, Jefferson, Jefferson,
Johnson, Knox, Lake,
Lamar, Lauderdale, Lauderdale,
Lawrence, Lawrence, Lee,
Lewis, Limestone, Lincoln,
Loudon, Lowndes, Macon,
Macon, Madison, Madison,
Marengo, Marion, Marion,
Marshall, Marshall, Maury,
McMinn, McNairy, Meigs,
Mobile, Monroe, Monroe,
Montgomery, Montgomery, Moore,
Morgan, Morgan, Obion,
Overton, Perry, Perry,
Pickens, Pickett, Pike,
Polk, Putnam, Randolph,
Rhea, Roane, Robertson,
Russell, Rutherford, Scott,
Sequatchie, Sevier, Shelby,
Shelby, Smith, St. Clair,
Stewart, Sullivan, Sumner,
Sumter, Talladega, Tallapoosa,
Tipton, Trousdale, Tuscaloosa,
Unicoi, Union, Van Buren,
Walker, Warren, Washington,
Washington, Wayne, Weakley,
White, Wilcox, Williamson,
Wilson, Winston,
|
|---|
|
|---|
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.
