2021 HumanaChoice R5826-018 (Regional PPO) R5826-018 By Humana.

Summary of Benefits for
2021 HumanaChoice R5826-018 (Regional PPO)


HumanaChoice R5826-018 (Regional PPO) R5826-018 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Humana available to residents in Florida. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The HumanaChoice R5826-018 (Regional PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out of pocket. This can be a extremely nice safety net.

HumanaChoice R5826-018 (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 R5826-018 (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.




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2021 Humana Medicare Advantage Plan Costs

Name:
HumanaChoice R5826-018 (Regional PPO)
Plan ID:
R5826-018
Provider:Humana
Year:2021
Type: Regional PPO *
Monthly Premium C+D: $0
Part C Premium:
MOOP: $7,550
Similar Plan: R5826-074






2021 HumanaChoice R5826-018 (Regional PPO) Summary of Benefits




Additional Benefits


No



Comprehensive Dental


Diagnostic services Not covered
Endodontics Not covered
Extractions 50% coinsurance (Out-of-Network)
Extractions 0% coinsurance
Non-routine services Not covered
Periodontics Not covered
Prosthodontics, other oral/maxillofacial surgery, other services 50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services 0% coinsurance
Restorative services 50% coinsurance (Out-of-Network)
Restorative services 0% coinsurance



Deductible


$1,300 annual deductible



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $45-75 copay or 30% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI) $45-125 copay
Diagnostic tests and procedures $0-100 copay
Diagnostic tests and procedures $0-45 copay or 30% coinsurance (Out-of-Network)
Lab services $0-50 copay
Lab services $45 copay or 30% coinsurance (Out-of-Network)
Outpatient x-rays $45 copay or 30% coinsurance (Out-of-Network)
Outpatient x-rays $10-100 copay



Doctor Visits


Primary $10 copay per visit
Primary $45 copay per visit (Out-of-Network)
Specialist $45 copay per visit
Specialist $45 copay per visit (Out-of-Network)



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $10-45 copay or 30% coinsurance per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $45 copay
Foot exams and treatment $45 copay (Out-of-Network)
Routine foot care Not covered



Ground Ambulance


$240 copay
$240 copay (Out-of-Network)



Hearing


Fitting/evaluation 25% coinsurance (Out-of-Network)
Fitting/evaluation $0 copay
Hearing aids 25% coinsurance (Out-of-Network)
Hearing aids $0 copay
Hearing exam $45 copay (Out-of-Network)
Hearing exam $45 copay



Inpatient Hospital Coverage


$311 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91 and beyond
$315 per day for days 1 through 7
$0 per day for days 8 through 90 (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies 30% coinsurance per item (Out-of-Network)
Diabetes supplies $0 copay or 20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Chemotherapy 20-30% coinsurance (Out-of-Network)
Other Part B drugs 20-30% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $245 per day for days 1 through 10
$0 per day for days 11 through 90 (Out-of-Network)
Inpatient hospital - psychiatric $195 per day for days 1 through 9
$0 per day for days 10 through 90
Outpatient group therapy visit $45 copay (Out-of-Network)
Outpatient group therapy visit $40 copay
Outpatient group therapy visit with a psychiatrist $45 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit $45 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit with a psychiatrist $45 copay (Out-of-Network)



MOOP


$10,000 In and Out-of-network
$7,550 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$45 copay or 30% coinsurance per visit (Out-of-Network)
$45-100 copay per visit



Preventive Care


$0 copay
$0-45 copay or 30% coinsurance (Out-of-Network)



Preventive Dental


Cleaning 50% coinsurance (Out-of-Network)
Cleaning $0 copay
Dental x-ray(s) $0 copay
Dental x-ray(s) 50% coinsurance (Out-of-Network)
Fluoride treatment Not covered
Oral exam $0 copay
Oral exam 50% coinsurance (Out-of-Network)



Rehabilitation Services


Occupational therapy visit $25-40 copay
Occupational therapy visit $45 copay or 30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit $45 copay or 30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit $25-40 copay



Skilled Nursing Facility


$250 per day for days 1 through 58
$0 per day for days 59 through 100 (Out-of-Network)
$0 per day for days 1 through 20
$150 per day for days 21 through 100



Transportation


Not covered



Vision


Contact lenses Not covered
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) Not covered
Other Not covered
Routine eye exam Not covered
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




Reviews for HumanaChoice R5826-018 (Regional PPO) R5826



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
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in HumanaChoice R5826-018 (Regional PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals


Health Plan Customer Service Rating for HumanaChoice R5826-018 (Regional PPO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


HumanaChoice R5826-018 (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?

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1-855-778-4180
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Sun 9am-6pm EST




Coverage Area for HumanaChoice R5826-018 (Regional PPO)

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, 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 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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