2020 Medicare Advantage Plan Services for
HumanaChoice R4182-004 (Regional PPO)

HumanaChoice R4182-004 (Regional PPO) R4182-004 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Humana available to residents in Texas. This plan includes additional Medicare prescription drug (Part-D) coverage. The HumanaChoice R4182-004 (Regional PPO) has a monthly premium of $54.00 and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out of pocket. This can be a extremely nice safety net.

HumanaChoice R4182-004 (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 works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for HumanaChoice R4182-004 (Regional PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

2020 Humana Medicare Advantage Plan Details

Part-C Premium

Humana plan charges a $28.20 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 R4182-004 (Regional PPO) has a monthly drug premium of $25.80 and a $175.00 drug deductible. This Humana plan offers a $25.80 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 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 $25.80. 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 R4182-004 (Regional PPO) medicare insurance offers a $5.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $10.20 for 75% low income subsidy $15.40 for 50% and $20.60 for 25%.

Gap Coverage

In 2020 once you and your plan provider have spent $4020 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Humana plan does not offer additional coverage through the gap.

Humana Drug Coverage and Formulary

A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 HumanaChoice R4182-004 (Regional PPO) R4182-004 Formulary here.

Drug Tier	Copay Preferred	Copay Nonpreferred
1	$6	$10
2	$13	$20
3	$47	$47
4	$99	$100
5	29%	29%

*Initial Coverage Phase and 30 day supply

See the 2020 Humana Formulary

2019 Plan Services

(*2020 Plan services will be added when available)

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Health plan deductible

$750 annual deductible

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Emergency care/Urgent care

Emergency		$90 per visit (always covered)
Urgent care		$25-45 or 40% per visit (always covered)

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Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures	Out-of-Network	40%
Diagnostic tests and procedures	In-Network	$0-175
Lab services	Out-of-Network	40%
Lab services	In-Network	$0-70
Diagnostic radiology services (e.g., MRI)	Out-of-Network	40%
Diagnostic radiology services (e.g., MRI)	In-Network	$45-325
Outpatient x-rays	Out-of-Network	40%
Outpatient x-rays	In-Network	$25-95

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Hearing

Hearing exam	Out-of-Network	40%
Hearing exam	In-Network	$45
Fitting/evaluation		Not covered
Hearing aids - inner ear		Not covered
Hearing aids - outer ear		Not covered
Hearing aids - over the ear		Not covered

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Preventive dental

Oral exam		Not covered
Cleaning		Not covered
Fluoride treatment		Not covered
Dental x-ray(s)		Not covered

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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

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Vision

Routine eye exam	Out-of-Network	$0 copay
Routine eye exam	In-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

Inpatient hospital - psychiatric	Out-of-Network	40% per stay
Inpatient hospital - psychiatric	In-Network	$360 per day for days 1 through 4 $0 per day for days 5 through 90
Outpatient group therapy visit with a psychiatrist	Out-of-Network	40%
Outpatient group therapy visit with a psychiatrist	In-Network	$40
Outpatient individual therapy visit with a psychiatrist	Out-of-Network	40%
Outpatient individual therapy visit with a psychiatrist	In-Network	$40
Outpatient group therapy visit	Out-of-Network	40%
Outpatient group therapy visit	In-Network	$40
Outpatient individual therapy visit	Out-of-Network	40%
Outpatient individual therapy visit	In-Network	$40

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Skilled Nursing Facility

	Out-of-Network	40% per stay
	In-Network	$0 per day for days 1 through 20 $172 per day for days 21 through 100

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Rehabilitation services

Occupational therapy visit	Out-of-Network	40%
Occupational therapy visit	In-Network	$25
Physical therapy and speech and language therapy visit	Out-of-Network	40%
Physical therapy and speech and language therapy visit	In-Network	$25

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Ground ambulance

	Out-of-Network	$265
	In-Network	$265

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Other health plan deductibles?

	In-Network	No

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Transportation

Not covered

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Foot care (podiatry services)

Foot exams and treatment	Out-of-Network	40%
Foot exams and treatment	In-Network	$45
Routine foot care		Not covered

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Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)	Out-of-Network	20% per item
Durable medical equipment (e.g., wheelchairs, oxygen)	In-Network	20% per item
Prosthetics (e.g., braces, artificial limbs)	Out-of-Network	25% per item
Prosthetics (e.g., braces, artificial limbs)	In-Network	20% per item
Diabetes supplies	Out-of-Network	25% per item
Diabetes supplies	In-Network	$0 or 10-20% per item

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

Covered

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Medicare Part B drugs

Chemotherapy	Out-of-Network	20-40%
Chemotherapy	In-Network	20%
Other Part B drugs	Out-of-Network	20-40%
Other Part B drugs	In-Network	20%

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

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

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Optional supplemental benefits

Yes

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Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

	In-Network	No

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Inpatient hospital coverage

	Out-of-Network	40% per stay
	In-Network	$360 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91

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Outpatient hospital coverage

	Out-of-Network	40% per visit
	In-Network	$325 per visit

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Doctor visits

Primary	Out-of-Network	40% per visit
Primary	In-Network	$25 per visit
Specialist	Out-of-Network	40% per visit
Specialist	In-Network	$45 per visit

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Preventive care

	Out-of-Network	$0 or 40-50%
	In-Network	$0 copay

Ratings for HumanaChoice R4182-004 (Regional PPO) R4182

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in HumanaChoice R4182-004 (Regional PPO) Plans Performance

Health Plan Customer Service Rating for HumanaChoice R4182-004 (Regional PPO)

HumanaChoice R4182-004 (Regional PPO) Drug Plan Customer Service ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Coverage Area for HumanaChoice R4182-004 (Regional PPO)

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Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, 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 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.