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2017 Medicare Advantage Plan Benefit Details for the HumanaChoice R5826-011 (Regional PPO)

2017 Medicare Advantage Plan Details
Medicare Plan Name:HumanaChoice R5826-011 (Regional PPO)
Location:Madison, Mississippi
Plan ID:R5826 - 011 - 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
Speak to a licensed sales agent to learn more and enroll.
Call Medicare Solutions at 855-373-9484 / TTY 711

Monday ‐ Friday 8:30am — 8pm ET
Email a copy of the HumanaChoice R5826-011 (Regional PPO) benefit details
— Medicare Plan Features —
Monthly Premium:$77.00 (see Plan Premium Details below)
Annual Deductible:$400 (Tier 1, 2 and 3 excluded from the Deductible.)
Annual Initial Coverage Limit (ICL):$3,700
Health Plan Type:Regional PPO
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$6,700
Gap Coverage:Yes
Total Number of Formulary Drugs:3,962 drugsBrowse the HumanaChoice R5826-011 (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:
Number of Drugs per
Plan's Pharmacy Search:https://www.humana.com/pharmacy/medicare/
Plan Offers Mail Order:Yes
Number of Members enrolled in this plan in Madison, Mississippi:156 members
Number of Members enrolled in this plan in Mississippi:5,849 members
Number of Members enrolled in this plan in (R5826 - 011):21,133 members
Plan’s Summary Star Rating: 3 out of 5 Stars.
Customer Service Rating: 2 out of 5 Stars.
Member Experience Rating: 3 out of 5 Stars.
Drug Cost Accuracy Rating: 3 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows:
Part C
Part D Base
Part D Supplemental
Monthly Premium with Extra Help Low-Income Subsidy (LIS):100%
Monthly Part D Premium with LIS:$0.00$0.00$0.00$0.00
Total Monthly Premium with LIS (Parts C & D):$41.90$41.90$41.90$41.90
— Plan Health Benefits —
** General Plan Information **
Choice of Doctors?:  Any Doctor
** Cost **
Monthly Health Plan Premium:  $41.90
Monthly Drug Plan Premium:  $35.10
Health Plan Deductible:  $1,000 annual deductible
Other Health Plan Deductibles?:  No
Maximum Out-of-Pocket Enrollee Responsibility (does not include prescription drugs) :  
  • $10,000 In and Out-of-network
  • $6,700 In-network
** Extra Benefits **
Prescription Drugs Covered?:  Yes
Optional Supplemental Benefits?:  No
** Outpatient Care and Services **
  • In-network: $265 or 20%
  • Out-of-network: $265 or 20%
Doctor's office visits:  
  • Primary Physician
    • In-network: $15 per visit
    • Out-of-network: $15 per visit
  • Specialist
    • In-network: $15-50 per visit
    • Out-of-network: $15-50 per visit
Durable medical equipment (wheelchairs, oxygen, etc.):  
  • In-network: 19% per item
  • Out-of-network: 19-25% per item
Emergency care:  $75 per visit (always covered)
Home health care:  
  • In-network: You pay nothing
  • Out-of-network: You pay nothing
Mental health care:  
  • In-network:
    • $275 for days 1 through 5
    • $0 for days 6 through 90
  • Out-of-network:
    • $275 for days 1 through 5
    • $0 for days 6 through 90
Outpatient hospital:  
  • In-network: $275 per visit
  • Out-of-network: $275 per visit
Renal dialysis:  
  • In-network: 20% per visit
  • Out-of-network: 19-25% per visit
** Inpatient Care **
Inpatient hospital care:  
  • In-network:
    • $275 for days 1 through 7
    • $0 for days 8 through 90
    • $0 for days 91 and beyond
  • Out-of-network:
    • $275 for days 1 through 7
    • $0 for days 8 through 90
Optional Supplemental Benefits?:  No
Skilled Nursing Facility (SNF):  
  • In-network:
    • $0 for days 1 through 20
    • $164.50 for days 21 through 100
  • Out-of-network:
    • $0 for days 1 through 20
    • $164.50 for days 21 through 100
Prescription Drugs Covered?:  Yes
** Additional Benefits **
Optional Supplemental Benefits?:  No

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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.
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  • 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.
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  • 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.
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  • 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.
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  • 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.