2023 HumanaChoice R4845-001 (Regional PPO)

HumanaChoice R4845-001 (Regional PPO) R4845-001 is a 2023 Medicare Advantage Plan or Part-C by Humana available to residents in Oklahoma and Kansas. This plan does not provide additional prescription drug (Part-D) coverage. Humana HumanaChoice R4845-001 (Regional PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $3,400 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $3,400 out-of-pocket. This can be an extremely nice safety net.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for HumanaChoice R4845-001 (Regional PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Oklahoma or Medicare Advantage in Kansas.




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2023 Humana Medicare Advantage Plan Overview

Name:HumanaChoice R4845-001 (Regional PPO)
Plan ID:R4845 001 0
Provider:Humana
Year:2023
Type:Regional PPO *
Combined Premium (C+D):$0/mo
MOOP:$3,400/yr
Similar Plan: R4845-002




What type of plan is HumanaChoice R4845-001 (Regional PPO)

HumanaChoice R4845-001 (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.

How much does HumanaChoice R4845-001 (Regional PPO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Humana charges a $0 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.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. HumanaChoice R4845-001 (Regional PPO) by Humana MOOP is $3,400. Once you spend $3,400 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.





Summary of Benefits

*2021 data this will be updated with 2023 data when available.

The benefit information provided is a summary of what HumanaChoice R4845-001 (Regional PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Humana helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.




Additional Benefits


No



Comprehensive Dental


Diagnostic services Not covered
Endodontics 70% coinsurance
Endodontics 55-75% coinsurance (Out-of-Network)
Extractions 50% coinsurance
Extractions 55-75% coinsurance (Out-of-Network)
Non-routine services 55-75% coinsurance (Out-of-Network)
Non-routine services 50% coinsurance
Periodontics 55-75% coinsurance (Out-of-Network)
Periodontics 70% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services 55-75% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services 70% coinsurance
Restorative services 50-70% coinsurance
Restorative services 55-75% coinsurance (Out-of-Network)



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) 40% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI) $35-180 copay or 20-25% coinsurance
Diagnostic tests and procedures $0-35 copay or 25% coinsurance
Diagnostic tests and procedures $0 copay or 40% coinsurance (Out-of-Network)
Lab services $0-30 copay or 25% coinsurance
Lab services 40% coinsurance (Out-of-Network)
Outpatient x-rays 40% coinsurance (Out-of-Network)
Outpatient x-rays $0-35 copay or 20-25% coinsurance



Doctor Visits


Primary 40% coinsurance per visit (Out-of-Network)
Primary $0 copay
Specialist 40% coinsurance per visit (Out-of-Network)
Specialist $35 copay per visit



Emergency care/Urgent Care


Emergency $120 copay per visit (always covered)
Urgent care $0-35 copay or 40% coinsurance per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment 40% coinsurance (Out-of-Network)
Foot exams and treatment $35 copay
Routine foot care Not covered



Ground Ambulance


$265 copay (Out-of-Network)
$265 copay



Hearing


Fitting/evaluation $0 copay (Out-of-Network)
Fitting/evaluation $0 copay
Hearing aids $399-699 copay
Hearing aids $399-699 copay (Out-of-Network)
Hearing exam 40% coinsurance (Out-of-Network)
Hearing exam $35 copay



Inpatient Hospital Coverage


$295 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
40% per stay (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies 40% coinsurance per item (Out-of-Network)
Diabetes supplies $0 copay or 10-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) 15% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 15% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 40% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Chemotherapy 20-40% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance
Other Part B drugs 20-40% coinsurance (Out-of-Network)



Mental Health Services


Inpatient hospital - psychiatric 40% per stay (Out-of-Network)
Inpatient hospital - psychiatric $295 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit $35 copay
Outpatient group therapy visit 40% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $35 copay
Outpatient group therapy visit with a psychiatrist 40% coinsurance (Out-of-Network)
Outpatient individual therapy visit $35 copay
Outpatient individual therapy visit 40% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist 40% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $35 copay



MOOP


$5,100 In and Out-of-network
$3,400 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$35 copay or 25% coinsurance per visit
40% coinsurance per visit (Out-of-Network)



Preventive Care


$0 copay or 40% coinsurance (Out-of-Network)
$0 copay



Preventive Dental


Cleaning $0 copay
Cleaning 50% coinsurance (Out-of-Network)
Dental x-ray(s) 50% coinsurance (Out-of-Network)
Dental x-ray(s) $0 copay
Fluoride treatment 50% coinsurance (Out-of-Network)
Fluoride treatment $0 copay
Oral exam 50% coinsurance (Out-of-Network)
Oral exam $0 copay



Rehabilitation Services


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



Skilled Nursing Facility


$0 per day for days 1 through 20
$178 per day for days 21 through 100
40% per stay (Out-of-Network)



Transportation


Not covered



Vision


Contact lenses $0 copay (Out-of-Network)
Contact lenses $0 copay
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) $0 copay (Out-of-Network)
Eyeglasses (frames and lenses) $0 copay
Other Not covered
Routine eye exam $0 copay
Routine eye exam $0 copay (Out-of-Network)
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings


Is HumanaChoice R4845-001 (Regional PPO) a good plan? HumanaChoice R4845-001 (Regional PPO) received a 3 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare HumanaChoice R4845-001 (Regional PPO) performance among several different plans.

2022 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
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with R4845-001 Health Plan

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


Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Humana

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


Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


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



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Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for HumanaChoice R4845-001 (Regional PPO) requires you to live in that plan’s service area. The service area is listed below:



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How much does HumanaChoice R4845-001 (Regional PPO) cost?

Humana charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is HumanaChoice R4845-001 (Regional PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. HumanaChoice R4845-001 (Regional PPO) by Humana MOOP is $3,400. Once you spend $3,400 you will pay nothing for Part A or Part B covered services.

What type of plan is HumanaChoice R4845-001 (Regional PPO)?

HumanaChoice R4845-001 (Regional PPO) is a Regional PPO *. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.

Is HumanaChoice R4845-001 (Regional PPO) a good plan?

HumanaChoice R4845-001 (Regional PPO) received a 3 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, 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 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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