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2011 Medicare Advantage Plan Benefit Details for the HumanaChoice R5826-066 (Regional PPO) - R5826-066-0
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2011 Medicare Advantage Plan Details
Medicare Plan Name:HumanaChoice R5826-066 (Regional PPO)
Location:Campbell, Kentucky     Click to see other locations
Plan ID:R5826 - 066 - 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 R5826-066 (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):$3,400
Number of Members enrolled in this plan in (R5826 - 066):5,851 members
— 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 **
Premium and Other Important Information
$0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
This plan covers all Medicare-covered preventive services with zero cost sharing.
$3 400 out-of-pocket limit.
This limit includes only Medicare-covered services.
$500 yearly deductible. Contact the plan for services that apply.
$5 100 out-of-pocket limit.
In-Network: This limit includes only Medicare-covered services.
Out-Of-Network: This limit includes only Medicare-covered services.
** Doctor and Hospital Choice **
Doctor and Hospital Choice
No referral required for network doctors specialists and hospitals.
You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.
Plan covers you when you travel in the U.S.
** Extra Benefits **
Prescription Drugs
Most drugs not covered.
0% to 20% of the cost for Part B-covered drugs (not including Part B-covered chemotherapy drugs).
20% of the cost for Part B-covered chemotherapy drugs.
0% to 30% of the cost for Part B drugs out-of-network.
This plan does not offer prescription drug coverage.
Physical Exams
$0 copay for routine exams.
Limited to 1 exam(s) every year.
$0 copay for the required Medicare-covered initial preventive physical exam and annual wellness visits.
30% of the cost for routine exams.
Vision Services
Authorization rules may apply.
In general routine eye exams and eye wear not covered. However this plan covers some vision benefits for an extra cost (see 'Optional Benefits').
$0 copay for
  • one pair of eyeglasses or contact lenses after cataract surgery
  • $0 to $30 copay for exams to diagnose and treat diseases and conditions of the eye.
    • $35 copay for eye exams.
    $0 copay for eye wear.
    Dental Services
    Authorization rules may apply.
    $30 copay for Medicare-covered dental benefits.
  • $0 copay for up to 1 oral exam(s) every year
  • $0 copay for up to 1 cleaning(s) every year
  • $0 copay for up to 1 dental x-ray(s) every year
    • 50% of the cost for preventive dental benefits.
    50% of the cost for comprehensive dental benefits.
    $35 copay for comprehensive dental benefits.
    Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits.
    ** Important Information **
    Premium and Other Important Information
    $0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
    Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
    This plan covers all Medicare-covered preventive services with zero cost sharing.
    $3 400 out-of-pocket limit.
    This limit includes only Medicare-covered services.
    $500 yearly deductible. Contact the plan for services that apply.
    $5 100 out-of-pocket limit.
    In-Network: This limit includes only Medicare-covered services.
    Out-Of-Network: This limit includes only Medicare-covered services.
    Doctor and Hospital Choice
    No referral required for network doctors specialists and hospitals.
    You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.
    Plan covers you when you travel in the U.S.
    ** Inpatient Care **
    Inpatient Hospital Care (Acute)
    No limit to the number of days covered by the plan each benefit period.
    For Medicare-covered hospital stays:
    Days 1 - 7: $225 copay per day
    Days 8 - 90: $0 copay per day
    $0 copay for each additional hospital day.
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    30% of the cost for each hospital stay.
    Inpatient Mental Health Care
    You get up to 190 days in a Psychiatric Hospital in a lifetime.
    For Medicare-covered hospital stays:
    Days 1 - 7: $225 copay per day
    Days 8 - 90: $0 copay per day
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    30% of the cost for each hospital stay.
    Skilled Nursing Facility (SNF)
    Authorization rules may apply.
    Plan covers up to 100 days each benefit period
    No prior hospital stay is required.
    For SNF stays:
    Days 1 - 14: $0 copay per day
    Days 15 - 100: $100 copay per day
    30% of the cost for each SNF stay.
    Home Health Care
    Authorization rules may apply.
    $0 copay for each Medicare-covered home health visit.
    20% for home health visits.
    Hospice
    You must get care from a Medicare-certified hospice.
    ** Outpatient Care **
    Doctor Office Visits
    See 'Welcome to Medicare; and Annual Wellness Visit' for more information.
    Authorization rules may apply.
    $10 copay for each primary care doctor visit for Medicare-covered benefits.
    $30 copay for each in-area network urgent care Medicare-covered visit.
    $30 copay for each specialist visit for Medicare-covered benefits.
    $35 copay for each primary care doctor visit.
    $35 copay for each specialist visit.
    Chiropractic Services
    Authorization rules may apply.
    $10 copay for each Medicare-covered visit.
    Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers.
    $35 copay for chiropractic benefits.
    Podiatry Services
    Authorization rules may apply.
    $30 copay for each Medicare-covered visit.
    Medicare-covered podiatry benefits are for medically-necessary foot care.
    $35 copay for podiatry benefits.
    Outpatient Mental Health Care
    Authorization rules may apply.
    $30 copay for each Medicare-covered individual or group therapy visit.
    $35 copay for Mental Health benefits.
    $35 copay for Mental Health benefits with a psychiatrist.
    Outpatient Substance Abuse Care
    Authorization rules may apply.
    $150 copay for Medicare-covered individual or group visits.
    $35 copay [or 30% of the cost] for outpatient substance abuse benefits.
    Outpatient Hospital Services
    Authorization rules may apply.
    $100 copay for each Medicare-covered ambulatory surgical center visit.
    $50 to $150 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit.
    30% of the cost for ambulatory surgical center benefits.
    30% of the cost for outpatient hospital facility benefits.
    Emergency Care
    $50 copay for Medicare-covered emergency room visits.
    Worldwide coverage.
    If you are admitted to the hospital within 24-hour(s) for the same condition you pay $0 for the emergency room visit
    Outpatient Rehabilitation Services
    Authorization rules may apply.
    $30 to $100 copay for Medicare-covered Occupational Therapy visits.
    $30 to $100 copay for Medicare-covered Physical and/or Speech and Language Therapy visits.
    $30 to $100 copay for Medicare-covered Cardiac Rehab services.
    $35 [or 30% of the cost] for Occupational Therapy benefits.
    $35 [or 30% of the cost] for Physical and/or Speech and Language Therapy visits.
    $35 [or 30% of the cost] for Cardiac Rehab services.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered items.
    20% of the cost for durable medical equipment.
    Prosthetic Devices
    Authorization rules may apply.
    20% of the cost for Medicare-covered items.
    20% of the cost for prosthetic devices.
    Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies
    Authorization rules may apply.
    $0 copay for Diabetes self-monitoring training.
    $0 copay for Nutrition Therapy for Diabetes.
    $0 to $10 copay [or 20% of the cost] for Diabetes supplies.
    30% of the cost for Diabetes self-monitoring training.
    30% of the cost for Nutrition Therapy for Diabetes.
    20% of the cost for Diabetes supplies.
    ** Preventive Services **
    Bone Mass Measurement
    $0 copay for Medicare-covered bone mass measurement.
    30% of the cost for Medicare-covered bone mass measurement.
    Colorectal Screening Exams
    $0 copay for Medicare-covered colorectal screenings.
    30% of the cost for colorectal screenings.
    Immunizations
    $0 copay for Flu and Pneumonia vaccines.
    No referral needed for Flu and pneumonia vaccines.
    $0 copay for Hepatitis B vaccine.
    $0 copay for immunizations.
    Pap Smears and Pelvic Exams
    Authorization rules may apply.
    $0 copay for Medicare-covered pap smears and pelvic exams
    30% of the cost for pap smears and pelvic exams.
    Prostate Cancer Screening Exams
    Authorization rules may apply.
    $0 copay for Medicare-covered prostate cancer screening.
    30% of the cost for prostate cancer screening.
    ** Additional Benefits **
    Dialysis
    Authorization rules may apply.
    0% to 20% of the cost for renal dialysis
    $0 copay for Nutrition Therapy for End-Stage Renal Disease.
    0% to 20% of the cost for renal dialysis.
    30% of the cost for Nutrition Therapy for End-Stage Renal Disease.
    Prescription Drugs
    Most drugs not covered.
    0% to 20% of the cost for Part B-covered drugs (not including Part B-covered chemotherapy drugs).
    20% of the cost for Part B-covered chemotherapy drugs.
    0% to 30% of the cost for Part B drugs out-of-network.
    This plan does not offer prescription drug coverage.
    Dental Services
    Authorization rules may apply.
    $30 copay for Medicare-covered dental benefits.
  • $0 copay for up to 1 oral exam(s) every year
  • $0 copay for up to 1 cleaning(s) every year
  • $0 copay for up to 1 dental x-ray(s) every year
    • 50% of the cost for preventive dental benefits.
    50% of the cost for comprehensive dental benefits.
    $35 copay for comprehensive dental benefits.
    Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits.
    Hearing Services
    Authorization rules may apply.
    In general routine hearing exams and hearing aids not covered.
  • $30 copay for Medicare-covered diagnostic hearing exams
    • $35 copay for hearing exams.
    Vision Services
    Authorization rules may apply.
    In general routine eye exams and eye wear not covered. However this plan covers some vision benefits for an extra cost (see 'Optional Benefits').
    $0 copay for
    • one pair of eyeglasses or contact lenses after cataract surgery
  • $0 to $30 copay for exams to diagnose and treat diseases and conditions of the eye.
    • $35 copay for eye exams.
    $0 copay for eye wear.
    Physical Exams
    $0 copay for routine exams.
    Limited to 1 exam(s) every year.
    $0 copay for the required Medicare-covered initial preventive physical exam and annual wellness visits.
    30% of the cost for routine exams.
    Health/Wellness Education
    The plan covers the following health/wellness education benefits:
  • Written health education materials including Newsletters
  • Additional Smoking Cessation
  • Health Club Membership/Fitness Classes
  • Nursing Hotline
    • $0 copay for each Medicare-covered smoking cessation counseling session.
    $0 copay for each Medicare-covered HIV screening.
    HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy.
    30% of the cost for Health and Wellness services.
    Transportation
    This plan does not cover routine transportation.
    Acupuncture
    This plan does not cover Acupuncture.
    ** Cost **
    Premium and Other Important Information
    Package: 1 - MyOption Vision:
    $14 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
    • Eye Exams
    • Eye Wear
    ** Extra Benefits **
    Vision Services
    $290 plan coverage limit for eye wear every year.
    $0 copay for
  • glasses
  • contacts
  • lenses
  • frames
  • $0 copay for up to 1 routine eye exam(s) every year
    • ** Important Information **
    Premium and Other Important Information
    Package: 1 - MyOption Vision:
    $14 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
    • Eye Exams
    • Eye Wear
    ** Additional Benefits **
    Vision Services
    $290 plan coverage limit for eye wear every year.
    $0 copay for
  • glasses
  • contacts
  • lenses
  • frames
  • $0 copay for up to 1 routine eye exam(s) every year
    • ** Cost **
    Premium and Other Important Information
    Package: 2 - MyOption Enhanced Dental PPO:
    $22 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
    • Preventive Dental
    • Comprehensive Dental
    ** Extra Benefits **
    Dental Services
  • $0 copay for up to 2 cleaning(s) every year
  • $0 copay for up to 2 oral exam(s) every year
  • $0 copay for up to 1 dental x-ray(s) every year
    • 50% of the cost for preventive dental services.
    50% to 75% of the cost for comprehensive dental services.
    $1 500 plan coverage limit for comprehensive dental benefits every year. This limit applies to both in-network and out-of-network benefits.
    Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits.
    ** Important Information **
    Premium and Other Important Information
    Package: 2 - MyOption Enhanced Dental PPO:
    $22 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
    • Preventive Dental
    • Comprehensive Dental
    ** Additional Benefits **
    Dental Services
  • $0 copay for up to 2 cleaning(s) every year
  • $0 copay for up to 2 oral exam(s) every year
  • $0 copay for up to 1 dental x-ray(s) every year
    • 50% of the cost for preventive dental services.
    50% to 75% of the cost for comprehensive dental services.
    $1 500 plan coverage limit for comprehensive dental benefits every year. This limit applies to both in-network and out-of-network benefits.
    Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits.
    ** Cost **
    Premium and Other Important Information
    Package: 3 - MyOption Points of Caregiving:
    $20 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
    • Other 1
    ** Important Information **
    Package: 3 - MyOption Points of Caregiving:
    $20 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
    • Other 1




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