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

$500 annual 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

Not covered

Other health plan deductibles?

	In-Network	No

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)

Covered

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

No

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,

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.