Medicare Advantage Plan Benefit Details in Plain Text |
The following Medicare Advantage plan benefits apply to the HumanaChoice R5826-069 (Regional PPO) (R5826 - 069) in Pawnee, Kansas .
This plan is administered by . To switch to a different Medicare Advantage plan or to change your location, click here. |
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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).
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This Medicare Advantage Plan without Prescription Drug Coverage is a Regional PPO * plan.
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Plan Membership and Plan Ratings |
The HumanaChoice R5826-069 (Regional PPO) (R5826 - 069) currently has 5,500 members. , and 635 members in Kansas.
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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: |
Please be aware that this plan does NOT include Prescription Drug Coverage! |
The HumanaChoice R5826-069 (Regional PPO) offers many Health Coverage Benefits. The following section will describe these benefits in detail. |
** General Plan Information ** |
Choice of Doctors?: Any Doctor |
** Cost ** |
Monthly Health Plan Premium: $0.00 |
Monthly Drug Plan Premium: Not Applicable |
Health Plan Deductible: $0 |
Other Health Plan Deductibles?: No |
Maximum Out-of-Pocket Enrollee Responsibility (does not include prescription drugs)
: - $10,000 In and Out-of-network
- $4,900 In-network
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** Extra Benefits ** |
Prescription Drugs Covered?: No |
Optional Supplemental Benefits?: Yes |
** Outpatient Care and Services ** |
Ambulance: - In-network: $265 or 20%
- Out-of-network: $265 or 20%
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Doctor's office visits: - Primary Physician
- In-network: You pay nothing
- Out-of-network: 40% per visit
- Specialist
- In-network: $35 per visit
- Out-of-network: 40% per visit
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Durable medical equipment (wheelchairs, oxygen, etc.): - In-network: 15% per item
- Out-of-network: 15% per item
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Emergency care: $75 per visit (always covered) |
Home health care: - In-network: You pay nothing
- Out-of-network: 40%
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Mental health care: - In-network:
- $318 for days 1 through 5
- $0 for days 6 through 90
- Out-of-network: 40% per stay
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Outpatient hospital: - In-network: 25% per visit
- Out-of-network: 40% per visit
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Renal dialysis: - In-network: 20% per visit
- Out-of-network: 20% per visit
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** Inpatient Care ** |
Inpatient hospital care: - In-network:
- $360 for days 1 through 5
- $0 for days 6 through 90
- $0 for days 91 and beyond
- Out-of-network: 40% per stay
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Optional Supplemental Benefits?: Yes |
Skilled Nursing Facility (SNF): - In-network:
- $0 for days 1 through 20
- $164.50 for days 21 through 100
- Out-of-network: 40% per stay
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Prescription Drugs Covered?: No |
** Additional Benefits ** |
Optional Supplemental Benefits?: Yes |
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