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.
Ready to Enroll?
Click Here |
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
2020 Humana Medicare Advantage Plan Details
| Name: | HumanaChoice R4182-004 (Regional PPO) |
|---|
| ID: | R4182-004 |
|---|
| Provider: | Humana |
|---|
| Year: | 2020 |
|---|
| Type: | Regional PPO |
|---|
| Monthly Premium C+D: | $54.00 |
|---|
| Part C Premium: | $28.20 |
|---|
| MOOP: | $6,700 |
|---|
| Part D (Drug) Premium: | $25.80 |
|---|
| Part D Supplemental Premium | $0.00 |
|---|
| Total Part D Premium: | $25.80 |
|---|
| Drug Deductible: | $175.00 |
|---|
| Tiers with No Deductible: | 1 |
|---|
| Gap Coverage: | No |
|---|
| Benchmark: | not below the regional benchmark |
|---|
| Type of Medicare Health: | Enhanced Alternative |
|---|
| Drug Benefit Type: | Enhanced |
|---|
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%.
| Full LIS Premium: | $5.00 |
|---|
| 75% LIS Premium: | $10.20 |
|---|
| 50% LIS Premium: | $15.40 |
|---|
| 25% LIS Premium: | $20.60 |
|---|
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.
2019 Plan Services
(*2020 Plan services will be added when available)
Health plan deductible
Emergency care/Urgent care
| Emergency |
|
$90 per visit (always covered) |
| Urgent care |
|
$25-45 or 40% per visit (always covered) |
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 |
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 |
Preventive dental
| Oral exam |
|
Not covered |
| Cleaning |
|
Not covered |
| Fluoride treatment |
|
Not covered |
| Dental x-ray(s) |
|
Not covered |
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 |
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 |
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 |
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 |
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 |
Ground ambulance
| |
Out-of-Network |
$265 |
| |
In-Network |
$265 |
Other health plan deductibles?
Transportation
Foot care (podiatry services)
| Foot exams and treatment |
Out-of-Network |
40% |
| Foot exams and treatment |
In-Network |
$45 |
| Routine foot care |
|
Not covered |
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 |
Wellness programs (e.g., fitness, nursing hotline)
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% |
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
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
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 |
Outpatient hospital coverage
| |
Out-of-Network |
40% per visit |
| |
In-Network |
$325 per visit |
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 |
Preventive care
| |
Out-of-Network |
$0 or 40-50% |
| |
In-Network |
$0 copay |
Ratings for HumanaChoice R4182-004 (Regional PPO) R4182
| 2019 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 | | |
|---|
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 | | |
|---|
| Rheumatoid Arthritis | | |
|---|
| Reducing Risk of Falling | | |
|---|
| Improving Bladder Control | | |
|---|
| Medication Reconciliation | | |
|---|
| Plan All-Cause Readmissions | | |
|---|
| Statin Therapy | | |
|---|
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 R4182-004 (Regional PPO) Plans Performance
| Total Rating | | |
|---|
| Complaints about Health Plan | | |
|---|
| Members Leaving the Plan | | |
|---|
| Health Plan Quality Improvement | | |
|---|
Health Plan Customer Service Rating for HumanaChoice R4182-004 (Regional PPO)
| Total Customer Service Rating | | |
|---|
| Timely Decisions About Appeals | | |
|---|
| Reviewing Appeals Decisions | | |
|---|
| Call Center, TTY, Foreign Language | | |
|---|
HumanaChoice R4182-004 (Regional PPO) Drug Plan Customer Service ratings
| Total Rating | | |
|---|
| Call Center, TTY, Foreign Language | | |
|---|
| Appeals Auto | | |
|---|
| Appeals Upheld | | |
|---|
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating | | |
|---|
| Complaints about the Drug Plan | | |
|---|
| Members Choosing to Leave the Plan | | |
|---|
| Drug Plan Quality Improvement | | |
|---|
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 | | |
|---|
| Statin with Diabetes | | |
|---|
Ready to Enroll?
Click Here |
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for HumanaChoice R4182-004 (Regional PPO)
(Click county to compare all available Advantage plans)
| State: |
Texas
| County: | Anderson, Andrews, Angelina, Aransas, Archer,
Armstrong, Atascosa, Austin, Bailey,
Bandera, Bastrop, Baylor, Bee,
Bell, Bexar, Blanco, Borden,
Bosque, Bowie, Brazoria, Brazos,
Brewster, Briscoe, Brooks, Brown,
Burleson, Burnet, Caldwell, Calhoun,
Callahan, Cameron, Camp, Carson,
Cass, Castro, Chambers, Cherokee,
Childress, Clay, Cochran, Coke,
Coleman, Collin, Collingsworth, Colorado,
Comal, Comanche, Concho, Cooke,
Coryell, Cottle, Crane, Crockett,
Crosby, Culberson, Dallam, Dallas,
Dawson, Deaf Smith, Delta, Denton,
DeWitt, Dickens, Dimmit, Donley,
Duval, Eastland, Ector, Edwards,
El Paso, Ellis, Erath, Falls,
Fannin, Fayette, Fisher, Floyd,
Foard, Fort Bend, Franklin, Freestone,
Frio, Gaines, Galveston, Garza,
Gillespie, Glasscock, Goliad, Gonzales,
Gray, Grayson, Gregg, Grimes,
Guadalupe, Hale, Hall, Hamilton,
Hansford, Hardeman, Hardin, Harris,
Harrison, Hartley, Haskell, Hays,
Hemphill, Henderson, Hidalgo, Hill,
Hockley, Hood, Hopkins, Houston,
Howard, Hudspeth, Hunt, Hutchinson,
Irion, Jack, Jackson, Jasper,
Jeff Davis, Jefferson, Jim Hogg, Jim Wells,
Johnson, Jones, Karnes, Kaufman,
Kendall, Kenedy, Kent, Kerr,
Kimble, King, Kinney, Kleberg,
Knox, La Salle, Lamar, Lamb,
Lampasas, Lavaca, Lee, Leon,
Liberty, Limestone, Lipscomb, Live Oak,
Llano, Loving, Lubbock, Lynn,
Madison, Marion, Martin, Mason,
Matagorda, Maverick, McCulloch, McLennan,
McMullen, Medina, Menard, Midland,
Milam, Mills, Mitchell, Montague,
Montgomery, Moore, Morris, Motley,
Nacogdoches, Navarro, Newton, Nolan,
Nueces, Ochiltree, Oldham, Orange,
Palo Pinto, Panola, Parker, Parmer,
Pecos, Polk, Potter, Presidio,
Rains, Randall, Reagan, Real,
Red River, Reeves, Refugio, Roberts,
Robertson, Rockwall, Runnels, Rusk,
Sabine, San Augustine, San Jacinto, San Patricio,
San Saba, Schleicher, Scurry, Shackelford,
Shelby, Sherman, Smith, Somervell,
Starr, Stephens, Sterling, Stonewall,
Sutton, Swisher, Tarrant, Taylor,
Terrell, Terry, Throckmorton, Titus,
Tom Green, Travis, Trinity, Tyler,
Upshur, Upton, Uvalde, Val Verde,
Van Zandt, Victoria, Walker, Waller,
Ward, Washington, Webb, Wharton,
Wheeler, Wichita, Wilbarger, Willacy,
Williamson, Wilson, Winkler, Wise,
Wood, Yoakum, Young, Zapata,
Zavala,
|
|---|
|
|---|
Go to top
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.
