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

3.5

out 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

Monthly Premium

Health Portion of Premium

Drug Portion of Premium

Health Plan Deductible

Health Plan Max Out-of-Pocket

$10,000 In and Out-of-network
$6,200 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

http://www.humana.com/medicare

Plan Link

http://www.humana.com/medicare

Medical Benefits

Doctor Services

Primary doctor visit

In-network: $10 copay per visit
Out-of-network: 30% coinsurance per visit

Specialist visit

In-network: $35 copay per visit
Out-of-network: 30% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $0-105 copay
Out-of-network: $0 copay or 30% coinsurance

Lab services

In-network: $0-40 copay
Out-of-network: 30% coinsurance

Diagnostic radiology services (like MRI)

In-network: $45-295 copay
Out-of-network: 30% coinsurance

Outpatient x-rays

In-network: $10-95 copay
Out-of-network: 30% coinsurance

Emergency care

$90 copay per visit (always covered)

Urgent care

$10-35 copay or 30% coinsurance per visit (always covered)

Hospital Services

Inpatient hospital coverage

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

Outpatient hospital coverage

In-network: $45-295 copay 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

Preventive services

In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance

Ambulance

Ground ambulance

In-network: $270 copay
Out-of-network: $270 copay

Therapy services

Occupational therapy visit

In-network: $20-40 copay
Out-of-network: 30% coinsurance

Physical therapy & speech & language therapy visit

In-network: $20-40 copay
Out-of-network: 30% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $40 copay
Out-of-network: 30% coinsurance

Outpatient individual therapy with a psychiatrist

In-network: $40 copay
Out-of-network: 30% coinsurance

Outpatient group therapy visit

In-network: $40 copay
Out-of-network: 30% coinsurance

Outpatient individual therapy visit

In-network: $40 copay
Out-of-network: 30% coinsurance

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 13% coinsurance per item
Out-of-network: 20% coinsurance per item

Prosthetics (like braces, artificial limbs)

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

Diabetes supplies

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

Part B Drugs

Chemotherapy drugs

In-network: 20% coinsurance
Out-of-network: 20-30% coinsurance

Other Part B drugs

In-network: 20% coinsurance
Out-of-network: 20-30% coinsurance

Extra Benefits