HumanaChoice R5361-002 (Regional PPO)


Medicare Plan Details

2021 Plan
Monthly Premium
(select county for price)

 

by Humana
Additional Coverage
Hearing
Overall Government Star Rating
 3.5
out of 5 stars

State: Illinois

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

 

$120
$82
$38
Coming soon
$10,000 In and Out-of-network
$6,700 In-network
No
Yes
No
No

Medical Benefits

Doctor Services

In-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
In-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit

Tests, labs, & imaging

In-network: $0 copay or 20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
In-network: $0 copay or 20% coinsurance
Out-of-network: 20% coinsurance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
$90 copay per visit (always covered)
20% coinsurance per visit (always covered)

Hospital Services

In-network: $450 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Out-of-network: 20% per stay
In-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100

Preventive services

In-network: $0 copay
Out-of-network: $0 copay

Ambulance

In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Therapy services

In-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Mental health services

In-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Opioid treatment services

Covered

Other services

In-network: 15% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: $0 copay or 10-20% coinsurance per item
Out-of-network: 20% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$10.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$3.70 copay or 5% (whichever costs more)

Brand-name drugs :
$9.20 copay or 5% (whichever costs more)

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier25%

Part B Drugs

In-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Extra Benefits

Hearing

In-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

Not covered
Not covered
Not covered
Not covered

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
 3
 2
 3
 3
 3
 5
 4
 5
 4
No Rating
 4

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