HumanaChoice R0865-001 (Regional PPO)
Medicare Plan Details
2021 Plan
Monthly Premium
| (select county for price) |
by Humana
Additional Coverage
Hearing
Vision
Dental
Overall Government Star Rating
3.5out of 5 stars
State: Indiana
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B
Plan Details
$0
$0
$0
$0
$10,000 In and Out-of-network
$6,200 In-network
$6,200 In-network
No
Yes
Yes
Yes
Medical Benefits
Doctor Services
In-network: $10 copay per visit
Out-of-network: 30% coinsurance per visit
Out-of-network: 30% coinsurance per visit
In-network: $35 copay per visit
Out-of-network: 30% coinsurance per visit
Out-of-network: 30% coinsurance per visit
Tests, labs, & imaging
In-network: $0-105 copay
Out-of-network: $0 copay or 30% coinsurance
Out-of-network: $0 copay or 30% coinsurance
In-network: $0-40 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $45-295 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $10-95 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
$90 copay per visit (always covered)
$10-35 copay or 30% coinsurance per visit (always covered)
Hospital Services
In-network: $295 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
Out-of-network: 30% per stay
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
Out-of-network: 30% per stay
In-network: $45-295 copay per visit
Out-of-network: 30% coinsurance per visit
Out-of-network: 30% coinsurance per visit
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: 30% per stay
$178 per day for days 21 through 100
Out-of-network: 30% per stay
Preventive services
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance
Out-of-network: $0 copay or 30% coinsurance
Ambulance
In-network: $270 copay
Out-of-network: $270 copay
Out-of-network: $270 copay
Therapy services
In-network: $20-40 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $20-40 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Mental health services
In-network: $40 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $40 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $40 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $40 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Opioid treatment services
Covered
Other services
In-network: 13% coinsurance per item
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: 20% coinsurance per item
Out-of-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
Out-of-network: 20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Part B Drugs
In-network: 20% coinsurance
Out-of-network: 20-30% coinsurance
Out-of-network: 20-30% coinsurance
In-network: 20% coinsurance
Out-of-network: 20-30% coinsurance
Out-of-network: 20-30% coinsurance
Extra Benefits
Hearing
In-network: $35 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $199-499 copay
Out-of-network: $199-499 copay
Out-of-network: $199-499 copay
Preventive Dental
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Not covered
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Not covered
Not covered
Not covered
Other benefits
Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
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