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

2013 HumanaChoice R5826-018 (Regional PPO) in Miami-Dade, Florida 33142

Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the HumanaChoice R5826-018 (Regional PPO) (R5826 - 018) in Miami-Dade, Florida 33142.

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 R5826-018 (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 R5826-018 (Regional PPO) (R5826 - 018) currently has 5,064 members.

The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3.5 stars. The detail CMS plan carrier ratings are as follows:
  • Customer Service Rating of 5 out of 5 stars
  • Member Experience Rating of 2 out of 5 stars
Please be aware that this plan does NOT include Prescription Drug Coverage!
The HumanaChoice R5826-018 (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.go
$4 000 out-of-pocket limit for Medicare-covered services.
$6 000 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. or its territories.
** 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.go
$4 000 out-of-pocket limit for Medicare-covered services.
$6 000 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. or its territories.
** 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 - 10: $150 copay per day
  • Days 11 - 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.
    For hospital stays:
    • Days 1 - 10: $150 copay per day
  • Days 11 - 90: $0 copay per day
    • 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 - 10: $140 copay per day
  • Days 11 - 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.
    For hospital stays:
    • Days 1 - 10: $140 copay per day
  • Days 11 - 90: $0 copay per day
    • 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 - 7: $0 copay per day
  • Days 8 - 100: $50 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 Medicare-covered 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
    $10 copay for each Medicare-covered primary care doctor visit.
    $35 copay for each Medicare-covered specialist visit.
    $45 copay for each Medicare-covered primary care doctor visit
    $45 copay for each Medicare-covered specialist visit
    Chiropractic Services
    $20 copay for each Medicare-covered chiropractic 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.
    $45 copay for Medicare-covered chiropractic visits.
    Podiatry Services
    $35 copay for each Medicare-covered podiatry visit
    Medicare-covered podiatry visits are for medically-necessary foot care.
    $45 copay for Medicare-covered podiatry visits
    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
    $45 copay for Medicare-covered Mental Health visits with a psychiatrist
    $45 copay for Medicare-covered Mental Health visits
    30% of the cost for Medicare-covered partial hospitalization program services
    Outpatient Substance Abuse Care
    Authorization rules may apply.
    $100 copay for Medicare-covered individual substance abuse outpatient treatment visits
    $100 copay for Medicare-covered group substance abuse outpatient treatment visits
    30% of the cost Medicare-covered substance abuse outpatient treatment visits
    Outpatient Services
    Authorization rules may apply.
    $75 copay for each Medicare-covered ambulatory surgical center visit
    $100 to $125 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit
    30% of the cost for Medicare-covered outpatient hospital facility visits
    30% of the cost for Medicare-covered ambulatory surgical center visits
    Ambulance Services
    Authorization rules may apply.
    $200 copay for Medicare-covered ambulance benefits.
    $200 copay for Medicare-covered 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
    $45 copay for Medicare-covered urgently-needed-care visits
    Outpatient Rehabilitation Services
    Authorization rules may apply.
    $100 copay for Medicare-covered Occupational Therapy visits
    $100 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits
    $45 copay [or 30% of the cost] for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits
    $45 copay [or 30% of the cost] for Medicare-covered Occupational Therapy visits.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered durable medical equipment
    You may pay less if you purchase these items from the plan’s preferred manufacturers/vendors. Contact the plan for a list of non-preferred and preferred manufacturers/vendors.
    28% of the cost for Medicare-covered durable medical equipment
    Prosthetic Devices
    Authorization rules may apply.
    20% of the cost for Medicare-covered prosthetic devices
    30% of the cost for Medicare-covered prosthetic devices.
    Diabetes Programs and Supplies
    Authorization rules may apply.
    $0 copay for Medicare-covered Diabetes self-management training
    0% to 20% of the cost for Medicare-covered Diabetes monitoring supplies
    $10 copay for Medicare-covered Therapeutic shoes or inserts
    $45 copay [or 30% of the cost] for Medicare-covered Diabetes self-management training
    28% of the cost for Medicare-covered Diabetes monitoring supplies
    28% of the cost for Medicare-covered Therapeutic shoes or inserts
    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    Authorization rules may apply.
    $0 to $100 copay for Medicare-covered lab services
    $0 to $100 copay for Medicare-covered diagnostic procedures and tests
    $10 to $100 copay for Medicare-covered X-rays
    $75 to $125 copay for Medicare-covered diagnostic radiology services (not including X-rays)
    $35 copay [or 20% of the cost] for Medicare-covered therapeutic radiology services
    If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $10 to $35 may apply
    $45 copay [or 30% of the cost] for Medicare-covered therapeutic radiology services
    $45 copay [or 30% of the cost] for Medicare-covered outpatient X-rays
    $75 copay [or 30% of the cost] for Medicare-covered diagnostic radiology services
    $45 copay [or 30% of the cost] for Medicare-covered diagnostic procedures tests and lab services
    ** Preventive Services **
    Cardiac and Pulmonary Rehabilitation Services
    Authorization rules may apply.
    $35 to $100 copay for Medicare-covered Cardiac Rehabilitation Services
    $35 to $100 copay for Medicare-covered Intensive Cardiac Rehabilitation Services
    $35 to $100 copay for Medicare-covered Pulmonary Rehabilitation Services
    $45 copay [or 30% of the cost] for Medicare-covered Cardiac Rehabilitation Services
    $45 copay [or 30% of the cost] for Medicare-covered Intensive Cardiac Rehabilitation Services
    $45 copay [or 30% of the cost] for Medicare-covered Pulmonary Rehabilitation Services
    Preventive Services and Wellness/Education Programs
    $0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.
    $0 copay for an annual physical exam
    The plan covers the following supplemental education/wellness programs:
    • Health Education
  • Health Club Membership/Fitness Classes
  • Nursing Hotline
    • $0 to $45 copay [or 30% of the cost] for Medicare-covered preventive services
    $45 copay for an annual physical exam
    50% of the cost for supplemental education/wellness programs
    Kidney Disease and Conditions
    Authorization rules may apply.
    0% to 20% of the cost for Medicare-covered renal dialysis
    $0 copay for Medicare-covered kidney disease education services
    $45 copay for Medicare-covered kidney disease education services
    0% to 20% of the cost for Medicare-covered renal dialysis
    Outpatient Prescription Drugs
    20% to 30% of the cost for Medicare Part B drugs out-of-network.
    Most drugs not covered.
    20% of the cost for Medicare Part B chemotherapy drugs and other Part B drugs.
    This plan does not offer prescription drug coverage.
    Dental Services
    Authorization rules may apply.
    In general preventive dental benefits (such as cleaning) not covered.
    $35 copay for Medicare-covered dental benefits
    $45 copay for Medicare-covered 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
    $45 copay for Medicare-covered diagnostic hearing exams.
    ** Additional Benefits **
    Vision Services
    • $0 copay for one pair of Medicare-covered eyeglasses or contact lenses after cataract surgery.
  • $0 to $35 copay for Medicare-covered exams to diagnose and treat diseases and conditions of the eye.
  • $0 copay for up to 1 supplemental routine eye exam(s) every year
    • $45 copay for Medicare-covered eye exams
    $0 copay for supplemental eye exams
    $0 copay for Medicare-covered eye wear
    $40 plan coverage limit for supplemental routine eye exams every year. This limit applies to both in-network and out-of-network benefits.
    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 - 10: $150 copay per day
  • Days 11 - 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.
    For hospital stays:
    • Days 1 - 10: $150 copay per day
  • Days 11 - 90: $0 copay per day
    • ** Outpatient Care **
    Doctor Office Visits
    $10 copay for each Medicare-covered primary care doctor visit.
    $35 copay for each Medicare-covered specialist visit.
    $45 copay for each Medicare-covered primary care doctor visit
    $45 copay for each Medicare-covered specialist visit
    Outpatient Services
    Authorization rules may apply.
    $75 copay for each Medicare-covered ambulatory surgical center visit
    $100 to $125 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit
    30% of the cost for Medicare-covered outpatient hospital facility visits
    30% of the cost for Medicare-covered ambulatory surgical center visits
    Ambulance Services
    Authorization rules may apply.
    $200 copay for Medicare-covered ambulance benefits.
    $200 copay for Medicare-covered ambulance benefits.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered durable medical equipment
    You may pay less if you purchase these items from the plan’s preferred manufacturers/vendors. Contact the plan for a list of non-preferred and preferred manufacturers/vendors.
    28% of the cost for Medicare-covered durable medical equipment
    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    Authorization rules may apply.
    $0 to $100 copay for Medicare-covered lab services
    $0 to $100 copay for Medicare-covered diagnostic procedures and tests
    $10 to $100 copay for Medicare-covered X-rays
    $75 to $125 copay for Medicare-covered diagnostic radiology services (not including X-rays)
    $35 copay [or 20% of the cost] for Medicare-covered therapeutic radiology services
    If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $10 to $35 may apply
    $45 copay [or 30% of the cost] for Medicare-covered therapeutic radiology services
    $45 copay [or 30% of the cost] for Medicare-covered outpatient X-rays
    $75 copay [or 30% of the cost] for Medicare-covered diagnostic radiology services
    $45 copay [or 30% of the cost] for Medicare-covered 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.




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