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2016 Medicare Advantage Plan Benefit Details for the HumanaChoice R5826-068 (Regional PPO)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2016 Medicare Advantage Plan Details
Medicare Plan Name:HumanaChoice R5826-068 (Regional PPO)
Location:Tishomingo, Mississippi     Click to see other locations
Plan ID:R5826 - 068 - 0     Click to see other plans
Member Services:1-800-457-4708 TTY users 711
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the HumanaChoice R5826-068 (Regional PPO) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 (see Plan Premium Details below)
Annual Deductible:no drug coverage
Health Plan Type:Regional PPO *
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$6,700
Number of Members enrolled in this plan in Tishomingo, Mississippi:13 members
Number of Members enrolled in this plan in Mississippi:2,945 members
Number of Members enrolled in this plan in (R5826 - 068):5,594 members
Plan’s Summary Star Rating: 3.5 out of 5 Stars.
• Customer Service Rating: 5 out of 5 Stars.
• Member Experience Rating: 4 out of 5 Stars.
• Drug Cost Accuracy Rating: 4 out of 5 Stars.
— Plan Premium Details —
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$0.00$0.00$0.00$0.00
— Plan Health Benefits —
** Cost **
Monthly premium, deductible, and limits on how much you pay for covered services
$0.00 per month. In addition you must keep paying your Medicare Part B premium.
This plan has deductibles for some hospital and medical services.
$500 per year for out-of-network services.
Yes. Like all Medicare health plans our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
Your yearly limit(s) in this plan:
  • $6 700 for services you receive from in-network providers.
  • $10 000 for services you receive from any provider. Your limit for services received from in-network providers will count toward this limit.
If you reach the limit on out-of-pocket costs you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.

Please note that you will still need to pay your monthly premiums.
Our plan has a coverage limit every year for certain benefits from any provider. Contact us for services that apply.
** Doctor and Hospital Choice **
Acupuncture
Not covered
** Extra Benefits **
Inpatient mental health care
For inpatient mental health care see the "Mental Health Care" section.
Outpatient prescription drugs
For Part B drugs such as chemotherapy drugs1:
  • In-network:  20% of the cost
  • Out-of-network:  30% of the cost
Other Part B drugs1:
  • In-network:  20% of the cost
  • Out-of-network:  30% of the cost
Our plan does not cover Part D prescription drug.
** Important Information **
Monthly premium, deductible, and limits on how much you pay for covered services
$0.00 per month. In addition you must keep paying your Medicare Part B premium.
This plan has deductibles for some hospital and medical services.
$500 per year for out-of-network services.
Yes. Like all Medicare health plans our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
Your yearly limit(s) in this plan:
  • $6 700 for services you receive from in-network providers.
  • $10 000 for services you receive from any provider. Your limit for services received from in-network providers will count toward this limit.
If you reach the limit on out-of-pocket costs you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.

Please note that you will still need to pay your monthly premiums.
Our plan has a coverage limit every year for certain benefits from any provider. Contact us for services that apply.
** Outpatient Care and Services **
Acupuncture
Not covered
Ambulance
  • In-network:  $300 copay
  • Out-of-network:  $300 copay
Chiropractic care
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):
  • In-network:  $20 copay
  • Out-of-network:  $50 copay
Dental services
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):
  • In-network:  $35 copay
  • Out-of-network:  $50 copay
Preventive dental services:
  • Cleaning (for up to 2 every year):
    • In-network:  You pay nothing
    • Out-of-network:  50% of the cost
  • Dental x-ray(s) (for up to 4):
    • In-network:  You pay nothing
    • Out-of-network:  50% of the cost
  • Fluoride treatment (for up to 2 every year):
    • In-network:  You pay nothing
    • Out-of-network:  50% of the cost
  • Oral exam (for up to 2 every year):
    • In-network:  You pay nothing
    • Out-of-network:  50% of the cost
    Diabetes supplies and services
    Diabetes monitoring supplies:
    • In-network:  0-20% of the cost depending on the supply
    • Out-of-network:  20-30% of the cost depending on the supply
    Diabetes self-management training:
    • In-network:  You pay nothing
    • Out-of-network:  $35-50 copay or 30% of the cost depending on the service
    Therapeutic shoes or inserts:
    • In-network:  $10 copay
    • Out-of-network:  20-30% of the cost depending on the supply
    Diagnostic tests, lab and radiology services, and x-rays (Costs for these services may be different if received in an outpatient surgery setting)
    Diagnostic radiology services (such as MRIs CT scans):
    • In-network:  $35-150 copay depending on the service
    • Out-of-network:  $50 copay or 30% of the cost depending on the service
    Diagnostic tests and procedures:
    • In-network:  $0-50 copay depending on the service
    • Out-of-network:  $35-50 copay or 30% of the cost depending on the service
    Lab services:
    • In-network:  $0-50 copay depending on the service
    • Out-of-network:  $35-50 copay or 30% of the cost depending on the service
    Outpatient x-rays:
    • In-network:  $10-50 copay depending on the service
    • Out-of-network:  $35-50 copay or 30% of the cost depending on the service
    Therapeutic radiology services (such as radiation treatment for cancer):
    • In-network:  $35-50 copay depending on the service
    • Out-of-network:  $50 copay or 30% of the cost depending on the service
    Doctor's office visits
    Primary care physician visit:
    • In-network:  $10 copay
    • Out-of-network:  $35 copay
    Specialist visit:
    • In-network:  $10-35 copay depending on the service
    • Out-of-network:  $50 copay
    Durable medical equipment (wheelchairs, oxygen, etc.)
    • In-network:  15% of the cost
    • Out-of-network:  20% of the cost
    If you go to a preferred vendor your cost may be less. Contact us for a list of preferred vendors.
    Emergency care
    $75 copay
    If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for emergency care. See the "Inpatient Hospital Care" section for other costs.
    Foot care (podiatry services)
    Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:
    • In-network:  $35 copay
    • Out-of-network:  $50 copay
    Hearing services
    Exam to diagnose and treat hearing and balance issues:
    • In-network:  $35 copay
    • Out-of-network:  $50 copay
    Home health care
    • In-network:  You pay nothing
    • Out-of-network:  30% of the cost
    Mental health care
    Inpatient visit:
    Our plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital.
    Our plan covers 90 days for an inpatient hospital stay.
    Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days you can use these extra days. But once you have used up these extra 60 days your inpatient hospital coverage will be limited to 90 days.
    • In-network:  
      • $125 copay per day for days 1 through 6
      • You pay nothing per day for days 7 through 90
        • Out-of-network:  
          • 30% of the cost per stay
            • Outpatient group therapy visit:
            • In-network:  $35 copay
            • Out-of-network:  $50 copay
            Outpatient individual therapy visit:
            • In-network:  $35 copay
            • Out-of-network:  $50 copay
            Outpatient rehabilitation
            Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks):
            • In-network:  $15 copay
            • Out-of-network:  30% of the cost
            Occupational therapy visit:
            • In-network:  $15 copay
            • Out-of-network:  30% of the cost
            Physical therapy and speech and language therapy visit:
            • In-network:  $15 copay
            • Out-of-network:  30% of the cost
            Outpatient substance abuse
            Group therapy visit:
            • In-network:  $35-50 copay depending on the service
            • Out-of-network:  $50 copay or 30% of the cost depending on the service
            Individual therapy visit:
            • In-network:  $35-50 copay depending on the service
            • Out-of-network:  $50 copay or 30% of the cost depending on the service
            Outpatient surgery
            Ambulatory surgical center:
            • In-network:  $100 copay
            • Out-of-network:  30% of the cost
            Outpatient hospital:
            • In-network:  $125 copay
            • Out-of-network:  30% of the cost
            Over-the-counter items
            Please visit our website to see our list of covered over-the-counter items.
            Prosthetic devices (braces, artificial limbs, etc.)
            Prosthetic devices:
            • In-network:  20% of the cost
            • Out-of-network:  30% of the cost
            Related medical supplies:
            • In-network:  20% of the cost
            • Out-of-network:  30% of the cost
            Renal dialysis
            • In-network:  20% of the cost
            • Out-of-network:  20% of the cost
            Transportation
            Not covered
            Urgently needed services
            $10-50 copay or 30% of the cost (up to $65) depending on the service
            Vision services
            Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):
            • In-network:  $0-35 copay depending on the service
            • Out-of-network:  $50 copay
            Routine eye exam (for up to 1 every year):
            • In-network:  You pay nothing
            • Out-of-network:  You pay nothing
            Our plan pays up to $75 every year for routine eye exams from any provider.
            Contact lenses (for up to 1 every year):
            • In-network:  You pay nothing
            • Out-of-network:  You pay nothing
            Eyeglasses (frames and lenses) (for up to 1 every year):
            • In-network:  You pay nothing
            • Out-of-network:  You pay nothing
            Eyeglasses or contact lenses after cataract surgery:
            • In-network:  You pay nothing
            • Out-of-network:  You pay nothing
            Our plan pays up to $200 every year for contact lenses and eyeglasses (frames and lenses) from any provider.
            ** Hospice **
            Hospice
            You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care.
            ** Preventive Care **
            Preventive care
            • In-network:  You pay nothing
            • Out-of-network:  $0-50 copay or 30% of the cost depending on the service
            Our plan covers many preventive services including:
            • Abdominal aortic aneurysm screening
            • Alcohol misuse counseling
            • Bone mass measurement
            • Breast cancer screening (mammogram)
            • Cardiovascular disease (behavioral therapy)
            • Cardiovascular screenings
            • Cervical and vaginal cancer screening
            • Colorectal cancer screenings (Colonoscopy Fecal occult blood test Flexible sigmoidoscopy)
            • Depression screening
            • Diabetes screenings
            • HIV screening
            • Medical nutrition therapy services
            • Obesity screening and counseling
            • Prostate cancer screenings (PSA)
            • Sexually transmitted infections screening and counseling
            • Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
            • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
            • "Welcome to Medicare" preventive visit (one-time)
            • Yearly "Wellness" visit
            Any additional preventive services approved by Medicare during the contract year will be covered.
            ** Inpatient Care **
            Inpatient hospital care
            Our plan covers an unlimited number of days for an inpatient hospital stay.
            • In-network:  
              • $125 copay per day for days 1 through 6
              • You pay nothing per day for days 7 through 90
              • You pay nothing per day for days 91 and beyond
                • Out-of-network:  
                  • 30% of the cost per stay
                    • Inpatient mental health care
                    For inpatient mental health care see the "Mental Health Care" section.
                    Skilled Nursing Facility (SNF)
                    Our plan covers up to 100 days in a SNF.
                    • In-network:  
                      • You pay nothing per day for days 1 through 20
                      • $160 copay per day for days 21 through 100
                        • Out-of-network:  
                          • 30% of the cost per stay
                            • Outpatient prescription drugs
                            For Part B drugs such as chemotherapy drugs1:
                            • In-network:  20% of the cost
                            • Out-of-network:  30% of the cost
                            Other Part B drugs1:
                            • In-network:  20% of the cost
                            • Out-of-network:  30% of the cost
                            Our plan does not cover Part D prescription drug.
                            ** Outpatient Care **
                            Diabetes supplies and services
                            Diabetes monitoring supplies:
                            • In-network:  0-20% of the cost depending on the supply
                            • Out-of-network:  20-30% of the cost depending on the supply
                            Diabetes self-management training:
                            • In-network:  You pay nothing
                            • Out-of-network:  $35-50 copay or 30% of the cost depending on the service
                            Therapeutic shoes or inserts:
                            • In-network:  $10 copay
                            • Out-of-network:  20-30% of the cost depending on the supply
                            Foot care (podiatry services)
                            Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:
                            • In-network:  $35 copay
                            • Out-of-network:  $50 copay
                            Hearing services
                            Exam to diagnose and treat hearing and balance issues:
                            • In-network:  $35 copay
                            • Out-of-network:  $50 copay
                            ** Outpatient Medical Services and Supplies **
                            Outpatient substance abuse
                            Group therapy visit:
                            • In-network:  $35-50 copay depending on the service
                            • Out-of-network:  $50 copay or 30% of the cost depending on the service
                            Individual therapy visit:
                            • In-network:  $35-50 copay depending on the service
                            • Out-of-network:  $50 copay or 30% of the cost depending on the service
                            Prosthetic devices (braces, artificial limbs, etc.)
                            Prosthetic devices:
                            • In-network:  20% of the cost
                            • Out-of-network:  30% of the cost
                            Related medical supplies:
                            • In-network:  20% of the cost
                            • Out-of-network:  30% of the cost
                            ** Additional Benefits **
                            Inpatient mental health care
                            For inpatient mental health care see the "Mental Health Care" section.




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