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This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2012 HumanaChoice R5826-067 (Regional PPO) in Barry, Missouri

Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the HumanaChoice R5826-067 (Regional PPO) (R5826 - 067) in Barry, Missouri .

This plan is administered by .  To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the HumanaChoice R5826-067 (Regional PPO) health benefit details in chart format or email and view benefits chart

Plan Premium
This plan has a $0.00 monthly premium. Although you pay no additional monthly premium, you must continue to pay your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).

This Medicare Advantage Plan without Prescription Drug Coverage is a Regional PPO * plan.

Plan Membership and Plan Ratings
The HumanaChoice R5826-067 (Regional PPO) (R5826 - 067) currently has 2,446 members.

The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3 stars. The detail CMS plan carrier ratings are as follows:
  • Customer Service Rating of 3 out of 5 stars
  • Member Experience Rating not available
Please be aware that this plan does NOT include Prescription Drug Coverage!
The HumanaChoice R5826-067 (Regional PPO) offers many Health Coverage Benefits. The following section will describe these benefits in detail.

** 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.
Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept 'assignment' from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept Medicare 'assignment ' your coinsurance can be based on the Medicare-approved amount plus an additional amount up to a higher Medicare 'limiting charge.' If you are a member of a plan that charges a copay for out-of-network physician services the higher Medicare 'limiting charge' does not apply. See the publications Medicare You or Your Medicare Benefits available on www.medicare.gov for a full listing of benefits under Original Medicare as well as for explanations of the rules related to 'assignment' and 'limiting charges' that apply by benefit type. To find out if physicians and DME suppliers accept assignment or participate in Medicare visit www.medicare.gov/physician or www.medicare.gov/supplier. You can also call 1-800
$3 400 out-of-pocket limit for Medicare-covered services.
$5 100 out-of-pocket limit for 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 **
Over-the-Counter Items
The plan does not cover Over-the-Counter items.
Transportation
This plan does not cover supplemental routine transportation.
** 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.
Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept 'assignment' from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept Medicare 'assignment ' your coinsurance can be based on the Medicare-approved amount plus an additional amount up to a higher Medicare 'limiting charge.' If you are a member of a plan that charges a copay for out-of-network physician services the higher Medicare 'limiting charge' does not apply. See the publications Medicare You or Your Medicare Benefits available on www.medicare.gov for a full listing of benefits under Original Medicare as well as for explanations of the rules related to 'assignment' and 'limiting charges' that apply by benefit type. To find out if physicians and DME suppliers accept assignment or participate in Medicare visit www.medicare.gov/physician or www.medicare.gov/supplier. You can also call 1-800
$3 400 out-of-pocket limit for Medicare-covered services.
$5 100 out-of-pocket limit for 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
No limit to the number of days covered by the plan each hospital stay.
For Medicare-covered hospital stays:
Days 1 - 9: $225 copay per day
Days 10 - 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 of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.
For Medicare-covered hospital stays:
Days 1 - 9: $195 copay per day
Days 10 - 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 - 21: $50 copay per day
Days 22 - 100: $125 copay per day
30% of the cost for each SNF stay.
Home Health Care
Authorization rules may apply.
$0 copay for Medicare-covered home health visits
30% of the cost for home health visits
Hospice
You must get care from a Medicare-certified hospice. Your plan will pay for a consultative visit before you select hospice.
** Outpatient Care **
Doctor Office Visits
$15 copay for each primary care doctor visit for Medicare-covered benefits.
$35 copay for each in-area network urgent care Medicare-covered visit
$35 copay for each specialist visit for Medicare-covered benefits.
30% of the cost for each primary care doctor visit
30% of the cost for each specialist visit
Chiropractic Services
Authorization rules may apply.
$15 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.
30% of the cost for chiropractic benefits.
Podiatry Services
Authorization rules may apply.
$35 copay for each Medicare-covered visit
Medicare-covered podiatry benefits are for medically-necessary foot care.
30% of the cost for podiatry benefits.
Outpatient Mental Health Care
Authorization rules may apply.
$35 copay for each Medicare-covered individual therapy visit
$35 copay for each Medicare-covered group therapy visit
$35 copay for each Medicare-covered individual therapy visit with a psychiatrist
$35 copay for each Medicare-covered group therapy visit with a psychiatrist
$35 copay for Medicare-covered partial hospitalization program services
30% of the cost for Mental Health benefits with a psychiatrist
30% of the cost for Mental Health benefits
30% of the cost for partial hospitalization program services
Outpatient Substance Abuse Care
Authorization rules may apply.
25% of the cost for Medicare-covered individual visits
25% of the cost for Medicare-covered group visits
30% of the cost for outpatient substance abuse benefits.
Outpatient Services/Surgery
Authorization rules may apply.
20% of the cost for each Medicare-covered ambulatory surgical center visit
20% to 25% of the cost for each Medicare-covered outpatient hospital facility visit
30% of the cost for outpatient hospital facility benefits.
30% of the cost for ambulatory surgical center benefits.
Ambulance Services
Authorization rules may apply.
20% of the cost for Medicare-covered ambulance benefits.
20% of the cost for ambulance benefits.
Emergency Care
$65 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.
Urgently Needed Care
30% of the cost for Medicare-covered urgently-needed-care visits
Outpatient Rehabilitation Services
Authorization rules may apply.
$35 copay [or 25% of the cost] for Medicare-covered Occupational Therapy visits
$35 copay [or 25% of the cost] for Medicare-covered Physical and/or Speech and Language Therapy visits
30% of the cost for Physical and/or Speech and Language Therapy visits
30% of the cost for Occupational Therapy benefits.
** Outpatient Medical Services and Supplies **
Durable Medical Equipment
Authorization rules may apply.
20% of the cost for Medicare-covered items
30% of the cost for durable medical equipment
Prosthetic Devices
Authorization rules may apply.
20% of the cost for Medicare-covered items
30% of the cost for prosthetic devices.
Diabetes Programs and Supplies
Authorization rules may apply.
$0 copay for Diabetes self-management training
0% to 20% of the cost for Diabetes monitoring supplies
$10 copay for Therapeutic shoes or inserts
30% of the cost for Diabetes self-management training
30% of the cost for Diabetes monitoring supplies
30% of the cost for Therapeutic shoes or inserts
'Diagnostic Tests, X-Rays, Lab Services, and Radiology Services'
Authorization rules may apply.
$0 to $35 copay [or 25% of the cost] for Medicare-covered lab services
$0 to $35 copay [or 0% to 25% of the cost] for Medicare-covered diagnostic procedures and tests
$15 to $35 copay [or 20% to 25% of the cost] for Medicare-covered X-rays
$15 to $35 copay [or 20% to 25% of the cost] for Medicare-covered diagnostic radiology services (not including X-rays)
$35 copay [or 20% of the cost] for Medicare-covered therapeutic radiology services
30% of the cost for therapeutic radiology services
30% of the cost for outpatient X-rays
30% of the cost for diagnostic radiology services
30% of the cost for diagnostic procedures tests and lab services
** Preventive Services **
Cardiac and Pulmonary Rehabilitation Services
Authorization rules may apply.
$35 copay [or 25% of the cost] for Medicare-covered Cardiac Rehabilitation Services
$35 copay [or 25% of the cost] for Medicare-covered Intensive Cardiac Rehabilitation Services
$35 copay [or 25% of the cost] for Medicare-covered Pulmonary Rehabilitation Services
30% of the cost for Cardiac Rehabilitation Services
30% of the cost for Intensive Cardiac Rehabilitation Services
30% of the cost for Pulmonary Rehabilitation Services
Preventive Services and Wellness/Education Programs
$0 copay for all preventive services covered under Original Medicare at zero cost sharing:
  • Abdominal Aortic Aneurysm screening
  • Bone Mass Measurement
  • Cardiovascular Screening
  • Cervical and Vaginal Cancer Screening (Pap Test and Pelvic Exam)
  • Colorectal Cancer Screening
  • Diabetes Screening
  • Influenza Vaccine
  • Hepatitis B Vaccine
  • HIV Screening
  • Breast Cancer Screening (Mammogram)
  • Medical Nutrition Therapy Services
  • Personalized Prevention Plan Services (Annual Wellness Visits)
  • Pneumococcal Vaccine
  • Prostate Cancer Screening (Prostate Specific Antigen (PSA) test only)
  • Smoking Cessation (Counseling to stop smoking)
  • Welcome to Medicare Physical Exam (Initial Preventive Physical Exam)
    • 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. Please contact plan for details.
    The plan covers the following supplemental education/wellness programs:
  • Written health education materials including Newsletters
  • Additional Smoking Cessation
  • Health Club Membership/Fitness Classes
  • Nursing Hotline
    • 30% of the cost for Medicare-covered preventive services
    50% of the cost for supplemental education/wellness programs
    Kidney Disease and Conditions
    Authorization rules may apply.
    0% to 20% of the cost for renal dialysis
    $0 copay for kidney disease education services
    30% of the cost for kidney disease education services
    0% to 20% of the cost for renal dialysis
    Outpatient 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.
    $0 copay for the following preventive dental benefits:
  • up to 1 oral exam(s) every year
  • up to 1 cleaning(s) every year
  • up to 1 dental x-ray(s) every year
    • $35 copay for Medicare-covered dental benefits
    30% of the cost for comprehensive dental benefits
    50% of the cost for preventive 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 supplemental routine hearing exams and hearing aids not covered.
  • $35 copay for Medicare-covered diagnostic hearing exams
    • 30% of the cost for hearing exams.
    ** Additional Benefits **
    Vision Services
    Authorization rules may apply.
    $0 copay for
  • one pair of eyeglasses or contact lenses after cataract surgery
  • $0 to $35 copay for exams to diagnose and treat diseases and conditions of the eye.
  • $0 copay for up to 1 supplemental routine eye exam(s) every year
    • 30% of the cost for eye exams.
    $0 copay for eye exams.
    $0 copay for eye wear.
    Over-the-Counter Items
    The plan does not cover Over-the-Counter items.
    Transportation
    This plan does not cover supplemental routine transportation.
    Acupuncture
    This plan does not cover Acupuncture.
    ** Inpatient Care **
    Inpatient Hospital Care
    No limit to the number of days covered by the plan each hospital stay.
    For Medicare-covered hospital stays:
    Days 1 - 9: $225 copay per day
    Days 10 - 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.
    ** Outpatient Care **
    Doctor Office Visits
    $15 copay for each primary care doctor visit for Medicare-covered benefits.
    $35 copay for each in-area network urgent care Medicare-covered visit
    $35 copay for each specialist visit for Medicare-covered benefits.
    30% of the cost for each primary care doctor visit
    30% of the cost for each specialist visit
    Outpatient Services/Surgery
    Authorization rules may apply.
    20% of the cost for each Medicare-covered ambulatory surgical center visit
    20% to 25% of the cost for each Medicare-covered outpatient hospital facility visit
    30% of the cost for outpatient hospital facility benefits.
    30% of the cost for ambulatory surgical center benefits.
    Ambulance Services
    Authorization rules may apply.
    20% of the cost for Medicare-covered ambulance benefits.
    20% of the cost for ambulance benefits.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered items
    30% of the cost for durable medical equipment
    'Diagnostic Tests, X-Rays, Lab Services, and Radiology Services'
    Authorization rules may apply.
    $0 to $35 copay [or 25% of the cost] for Medicare-covered lab services
    $0 to $35 copay [or 0% to 25% of the cost] for Medicare-covered diagnostic procedures and tests
    $15 to $35 copay [or 20% to 25% of the cost] for Medicare-covered X-rays
    $15 to $35 copay [or 20% to 25% of the cost] for Medicare-covered diagnostic radiology services (not including X-rays)
    $35 copay [or 20% of the cost] for Medicare-covered therapeutic radiology services
    30% of the cost for therapeutic radiology services
    30% of the cost for outpatient X-rays
    30% of the cost for diagnostic radiology services
    30% of the cost for diagnostic procedures tests and lab services
    ** Additional Benefits **
    Over-the-Counter Items
    The plan does not cover Over-the-Counter items.
    Transportation
    This plan does not cover supplemental routine transportation.
    ** Cost **
    Premium and Other Important Information
    Package: 1 - MyOption Enhanced Dental:
    $19 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
    • ** Important Information **
    Package: 1 - MyOption Enhanced Dental:
    $19 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
    • ** Preventive Services **
    Dental Services
    $0 copay for the following preventive dental benefits:
  • up to 2 oral exam(s) every year
  • up to 2 cleaning(s) every year
  • 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.




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