Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community
  • Home
  • Contact
  • MAPD
  • PDP
  • 2020
  • FAQs
  • Articles
  • Search
  • Contact
  • 2020
  • FAQs
  • Articles
  • Latest Medicare News
  • Search


2019 Medicare Advantage Plan Benefit Details for the HumanaChoice R4182-004 (Regional PPO) - R4182-004-0


2019 Medicare Advantage Plan Details
Medicare Plan Name:HumanaChoice R4182-004 (Regional PPO)
Location:Fayette, Texas
Plan ID:R4182 - 004 - 0     Click to see other plans
Member Services:1-800-457-4708 TTY users 711
— Enrollment Options —
Medicare Contact Information:1-800-MEDICARE (1-800-633-4227)
TTY users 1-877-486-2048
Advertisement
Speak to a licensed sales agent to learn more and enroll.
Call Medicare Solutions at 855-373-9484 / TTY 711

Monday ‐ Friday 8:30am — 10pm EST
MULTIPLAN_GHHJTEXEN_ACCEPTED
Email a copy of the HumanaChoice R4182-004 (Regional PPO) benefit details
— Medicare Plan Features —
Monthly Premium:$48.00 (see Plan Premium Details below)
Annual Deductible:$175 (Tier 1 and 2 excluded from the Deductible.)
Health Plan Type:Regional PPO
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$6,700
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:3,519 drugsBrowse the HumanaChoice R4182-004 (Regional PPO) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:
$6.00$13.00$47.00$99.0029%
Number of Drugs per
  Tier:
2915457281316639
Plan's Pharmacy Search:http:www.humana.com/medicare/medicare_prescription_drugs/
Plan Offers Mail Order?Yes
Number of Members enrolled in this plan in Fayette, Texas:197 members
Number of Members enrolled in this plan in (R4182 - 004):28,235 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 —
The Monthly Premium is Split as Follows:
Total
Premium
Part C
Premium
Part D Base
Premium
Part D Supplemental
Premium
$48.00$24.10$23.90$0.00
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$6.00$11.90$17.90
Total Monthly Premium with LIS (Parts C & D):$24.10$30.10$36.00$42.00
— Plan Health Benefits —
** Benefit Highlights **
Health plan deductible $750 annual deductible
Other health plan deductibles? In-Network:  No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) $10,000 In and Out-of-network
$6,700 In-network
Optional supplemental benefits Yes
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions? In-Network:  No
Inpatient hospital coverage In-Network:  $360 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
  Out-of-Network:  40% per stay
Outpatient hospital coverage In-Network:  $325 per visit
  Out-of-Network:  40% per visit
Doctor visits Primary:  In-Network:  $25 per visit
  Primary:  Out-of-Network:  40% per visit
  Specialist:  In-Network:  $45 per visit
  Specialist:  Out-of-Network:  40% per visit
Preventive care In-Network:  $0 copay
  Out-of-Network:  $0 or 40-50%
Emergency care/Urgent care Emergency:  $90 per visit (always covered)
  Urgent care:  $25-45 or 40% per visit (always covered)
Vision Routine eye exam:  In-Network:  $0 copay
  Routine eye exam:  Out-of-Network:  $0 copay
  Other:  Not covered
  Contact lenses:  Not covered
  Eyeglasses (frames and lenses):  Not covered
  Eyeglass frames:  Not covered
  Eyeglass lenses:  Not covered
  Upgrades:  Not covered
Mental health services Inpatient hospital - psychiatric:  In-Network:  $360 per day for days 1 through 4
$0 per day for days 5 through 90
  Inpatient hospital - psychiatric:  Out-of-Network:  40% per stay
  Outpatient group therapy visit with a psychiatrist:  In-Network:  $40
  Outpatient group therapy visit with a psychiatrist:  Out-of-Network:  40%
  Outpatient individual therapy visit with a psychiatrist:  In-Network:  $40
  Outpatient individual therapy visit with a psychiatrist:  Out-of-Network:  40%
  Outpatient group therapy visit:  In-Network:  $40
  Outpatient group therapy visit:  Out-of-Network:  40%
  Outpatient individual therapy visit:  In-Network:  $40
  Outpatient individual therapy visit:  Out-of-Network:  40%
Skilled Nursing Facility In-Network:  $0 per day for days 1 through 20
$172 per day for days 21 through 100
  Out-of-Network:  40% per stay
Rehabilitation services Occupational therapy visit:  In-Network:  $25
  Occupational therapy visit:  Out-of-Network:  40%
  Physical therapy and speech and language therapy visit:  In-Network:  $25
  Physical therapy and speech and language therapy visit:  Out-of-Network:  40%
Ground ambulance In-Network:  $265
  Out-of-Network:  $265
Transportation Not covered
Foot care (podiatry services) Foot exams and treatment:  In-Network:  $45
  Foot exams and treatment:  Out-of-Network:  40%
  Routine foot care:  Not covered
Medical equipment/supplies Durable medical equipment (e.g., wheelchairs, oxygen):  In-Network:  20% per item
  Durable medical equipment (e.g., wheelchairs, oxygen):  Out-of-Network:  20% per item
  Prosthetics (e.g., braces, artificial limbs):  In-Network:  20% per item
  Prosthetics (e.g., braces, artificial limbs):  Out-of-Network:  25% per item
  Diabetes supplies:  In-Network:  $0 or 10-20% per item
  Diabetes supplies:  Out-of-Network:  25% per item
Wellness programs (e.g., fitness, nursing hotline) Covered
Medicare Part B drugs Chemotherapy:  In-Network:  20%
  Chemotherapy:  Out-of-Network:  20-40%
  Other Part B drugs:  In-Network:  20%
  Other Part B drugs:  Out-of-Network:  20-40%
** Benefits Services **
Diagnostic procedures/lab services/imaging Diagnostic tests and procedures:  In-Network:  $0-175
  Diagnostic tests and procedures:  Out-of-Network:  40%
  Lab services:  In-Network:  $0-70
  Lab services:  Out-of-Network:  40%
  Diagnostic radiology services (e.g., MRI):  In-Network:  $45-325
  Diagnostic radiology services (e.g., MRI):  Out-of-Network:  40%
  Outpatient x-rays:  In-Network:  $25-95
  Outpatient x-rays:  Out-of-Network:  40%
Hearing Hearing exam:  In-Network:  $45
  Hearing exam:  Out-of-Network:  40%
  Fitting/evaluation:  Not covered
  Hearing aids - inner ear:  Not covered
  Hearing aids - outer ear:  Not covered
  Hearing aids - over the ear:  Not covered
Preventive dental Oral exam:  Not covered
  Cleaning:  Not covered
  Fluoride treatment:  Not covered
  Dental x-ray(s):  Not covered
Comprehensive dental Non-routine services:  Not covered
  Diagnostic services:  Not covered
  Restorative services:  Not covered
  Endodontics:  Not covered
  Periodontics:  Not covered
  Extractions:  Not covered
  Prosthodontics, other oral/maxillofacial surgery, other services:  Not covered
** Optional Supplemental Benefits **
Package #1 Comprehensive dental, Preventive dental
  Monthly Premium:  $16.60
  Deductible:  N/A
Package #2 Wellness programs (e.g., fitness, nursing hotline)
  Monthly Premium:  $15.00
  Deductible:  N/A


Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs





Have a Medication Not Covered by Your Plan?
Prescription Discounts are
easy as 1-2-3
  1. Locate lowest price drug and pharmacy
  2. Show card at pharmacy
  3. Get instant savings!
Your drug discount card is available to you at no cost.







Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.