PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Humana
CMS Rating
Plan Type
Regional PPO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2014
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$6,700 In-Network$7,500 In and Out-of-Network
Other Deductibles?
In Network: Yes. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$36.70
Monthly Health Plan Premium
$28.30

Benefits

Service
In Network
Out of Network
Inpatient Hospital Care
Days 1-6: $275 copay per day. Days 7-90: $0 copay per day
40%
Inpatient Mental Health Care
$1,400 copay
40%
Skilled Nursing Facility (SNF)
Days 1-14: $0 copay per day. Days 15-21: $25 copay per day. Days 22-100: $150 copay per day
40%
Home Health Care
$0 maximum per visit
20% maximum per visit
Doctor Office Visits
$15 maximum per visit
40% maximum per visit
Outpatient Services
$275 maximum or 20% maximum per visit
40% maximum per visit
Ambulance Services
$250 maximum
$250 maximum
Emergency Care
$65 maximum per visit
Not Applicable
Durable Medical Equipment
15% maximum per item
25% maximum per item
Kidney Disease and Conditions
20% maximum per visit
20% maximum per visit
Specialist Office Visit
$40 maximum per visit
40% maximum per visit

Prescription Drug Coverage

Drugs Covered under Medicare Part B

General

20% of the cost for Medicare Part B chemotherapy drugs and other Part B drugs.

20% to 40% of the cost for Medicare Part B drugs out-of-network.


Drugs Covered under Medicare Part D

General

This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/ on the web.

Different out-of-pocket costs may apply for people who
  • have limited incomes,
  • live in long term care facilities, or
  • have access to Indian/Tribal/Urban (Indian Health Service) providers.


The plan offers national in-network prescription coverage (i.e., this would include 50 states and the District of Columbia). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel).

Total yearly drug costs are the total drug costs paid by both you and a Part D plan.

The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition.

Some drugs have quantity limits.

Your provider must get prior authorization from HumanaChoice R5826-012 (Regional PPO) for certain drugs.

You must go to certain pharmacies for a very limited number of drugs, due to special handling, provider coordination, or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website, formulary, printed materials, as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov.

If the actual cost of a drug is less than the normal cost-sharing amount for that drug, you will pay the actual cost, not the higher cost-sharing amount.

The plan charges a minimum cost sharing amount for certain low-cost drugs.

If you request a formulary exception for a drug and HumanaChoice R5826-012 (Regional PPO) approves the exception, you will pay Tier 4: Non-Preferred Brand cost sharing for that drug.

In-Network

$0 deductible.

Initial Coverage

You pay the following until total yearly drug costs reach $2,850:

Retail Pharmacy

Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

You can get drugs the following way(s):

Tier 1: Preferred Generic

  • $7 copay for a one-month (30-day) supply of drugs in this tier


  • $21 copay for a three-month (90-day) supply of drugs in this tier


  • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 2: Non-Preferred Generic

  • $12 copay for a one-month (30-day) supply of drugs in this tier


  • $36 copay for a three-month (90-day) supply of drugs in this tier


  • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 3: Preferred Brand

  • $45 copay for a one-month (30-day) supply of drugs in this tier


  • $135 copay for a three-month (90-day) supply of drugs in this tier


  • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 4: Non-Preferred Brand

  • $89 copay for a one-month (30-day) supply of drugs in this tier


  • $267 copay for a three-month (90-day) supply of drugs in this tier


Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

Tier 5: Specialty Tier

  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier


  • Long Term Care Pharmacy

    Long term care pharmacies must dispense brand name drugs in amounts less than a 14 days supply at a time. They may also dispense less than a month's supply of generic drugs at a time. Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

    You can get drugs the following way(s):

    Tier 1: Preferred Generic

    • $7 copay for a one-month (31-day) supply of drugs in this tier


    • Tier 2: Non-Preferred Generic

    • $12 copay for a one-month (31-day) supply of drugs in this tier


    • Tier 3: Preferred Brand

    • $45 copay for a one-month (31-day) supply of drugs in this tier


    • Tier 4: Non-Preferred Brand

    • $89 copay for a one-month (31-day) supply of drugs in this tier


    • Tier 5: Specialty Tier

    • 33% coinsurance for a one-month (31-day) supply of drugs in this tier



    Mail Order


    Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

    You can get drugs from a preferred and non-preferred mail order pharmacy the following way(s):

    Tier 1: Preferred Generic

    • $7 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


    • $0 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.


    • $7 copay for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


    • $21 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 2: Non-Preferred Generic

    • $12 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


    • $0 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.


    • $12 copay for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


    • $36 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 3: Preferred Brand

    • $45 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


    • $125 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.


    • $45 copay for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


    • $135 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 4: Non-Preferred Brand

    • $89 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


    • $257 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.


    • $89 copay for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


    • $267 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


    Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 5: Specialty Tier

  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • Coverage Gap

    After your total yearly drug costs reach $2,850, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 47.5% for the plan's costs for brand drugs and 72% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4,550.

    Additional Coverage Gap

    The plan covers few formulary generics (less than 10% of formulary generic drugs), few formulary brands (less than 10% of formulary brand drugs) through the coverage gap.

    The plan offers additional coverage in the gap for the following tiers. You pay the following:

    Retail Pharmacy

    Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

    Tier 1: Preferred Generic

    • $7 copay for a one-month (30-day) supply of certain drugs covered within this tier


    • $21 copay for a three-month (90-day) supply of certain drugs covered within this tier


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 2: Non-Preferred Generic

    • $12 copay for a one-month (30-day) supply of certain drugs covered within this tier


    • $36 copay for a three-month (90-day) supply of certain drugs covered within this tier


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 3: Preferred Brand

    • $45 copay for a one-month (30-day) supply of certain drugs covered within this tier


    • $135 copay for a three-month (90-day) supply of certain drugs covered within this tier


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 4: Non-Preferred Brand

    • $89 copay for a one-month (30-day) supply of certain drugs covered within this tier


    • $267 copay for a three-month (90-day) supply of certain drugs covered within this tier


    Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 5: Specialty Tier

  • 33% coinsurance for a one-month (30-day) supply of certain drugs covered within this tier


  • Long Term Care Pharmacy

    Long term care pharmacies must dispense brand name drugs in amounts less than a 14 days supply at a time. They may also dispense less than a month's supply of generic drugs at a time. Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

    Tier 1: Preferred Generic

    • $7 copay for a one-month (31-day) supply of certain drugs covered within this tier


    • Tier 2: Non-Preferred Generic

    • $12 copay for a one-month (31-day) supply of certain drugs covered within this tier


    • Tier 3: Preferred Brand

    • $45 copay for a one-month (31-day) supply of certain drugs covered within this tier


    • Tier 4: Non-Preferred Brand

    • $89 copay for a one-month (31-day) supply of certain drugs covered within this tier


    • Tier 5: Specialty Tier

    • 33% coinsurance for a one-month (31-day) supply of certain drugs covered within this tier



    Mail Order


    Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

    Tier 1: Preferred Generic

    • $7 copay for a one-month (30-day) supply of certain drugs covered within this tier from a preferred mail order pharmacy


    • $0 copay for a three-month (90-day) supply of certain drugs covered within this tier from a preferred mail order pharmacy


    • $7 copay for a one-month (30-day) supply of certain drugs covered within this tier from a non-preferred mail order pharmacy


    • $21 copay for a three-month (90-day) supply of certain drugs covered within this tier from a non-preferred mail order pharmacy


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 2: Non-Preferred Generic

    • $12 copay for a one-month (30-day) supply of certain drugs covered within this tier from a preferred mail order pharmacy


    • $0 copay for a three-month (90-day) supply of certain drugs covered within this tier from a preferred mail order pharmacy


    • $12 copay for a one-month (30-day) supply of certain drugs covered within this tier from a non-preferred mail order pharmacy


    • $36 copay for a three-month (90-day) supply of certain drugs covered within this tier from a non-preferred mail order pharmacy


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 3: Preferred Brand

    • $45 copay for a one-month (30-day) supply of certain drugs covered within this tier from a preferred mail order pharmacy


    • $125 copay for a three-month (90-day) supply of certain drugs covered within this tier from a preferred mail order pharmacy


    • $45 copay for a one-month (30-day) supply of certain drugs covered within this tier from a non-preferred mail order pharmacy


    • $135 copay for a three-month (90-day) supply of certain drugs covered within this tier from a non-preferred mail order pharmacy


    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

      Tier 4: Non-Preferred Brand

    • $89 copay for a one-month (30-day) supply of certain drugs covered within this tier from a preferred mail order pharmacy


    • $257 copay for a three-month (90-day) supply of certain drugs covered within this tier from a preferred mail order pharmacy


    • $89 copay for a one-month (30-day) supply of certain drugs covered within this tier from a non-preferred mail order pharmacy


    • $267 copay for a three-month (90-day) supply of certain drugs covered within this tier from a non-preferred mail order pharmacy


    Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.

    Tier 5: Specialty Tier

  • 33% coinsurance for a one-month (30-day) supply of certain drugs covered within this tier from a preferred mail order pharmacy


  • 33% coinsurance for a one-month (30-day) supply of certain drugs covered within this tier from a non-preferred mail order pharmacy


  • Please contact the plan for a complete list of drugs covered through the gap.

    Catastrophic Coverage

    After your yearly out-of-pocket drug costs reach $4,550, you pay the greater of:
    • 5% coinsurance, or
    • $2.55 copay for generic (including brand drugs treated as generic) and a $6.35 copay for all other drugs.


    Out-of-Network

    Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from HumanaChoice R5826-012 (Regional PPO).

    You can get out-of-network drugs the following way:

    Out-of-Network Initial Coverage

    You will be reimbursed up to the plan's cost of the drug minus the following for drugs purchased out-of-network until total yearly drug costs reach $2,850:

    Out-of-Network Initial Coverage

    Tier 1: Preferred Generic

    • $7 copay for a one-month (30-day) supply of drugs in this tier


    • Tier 2: Non-Preferred Generic

    • $12 copay for a one-month (30-day) supply of drugs in this tier


    • Tier 3: Preferred Brand

    • $45 copay for a one-month (30-day) supply of drugs in this tier


    • Tier 4: Non-Preferred Brand

    • $89 copay for a one-month (30-day) supply of drugs in this tier


    • Tier 5: Specialty Tier

    • 33% coinsurance for a one-month (30-day) supply of drugs in this tier


    You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.

    Out-of-Network Coverage Gap

    You will be reimbursed up to 28% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4,550. Please note that the plan allowable cost may be less than the out-of-network pharmacy price paid for your drug(s). You will be reimbursed up to 52.5% of the plan allowable cost for brand name drugs purchased out-of-network until your total yearly out-of-pocket drug costs reach $4,550. Please note that the plan allowable cost may be less than the out-of-network pharmacy price paid for your drug(s).

    Additional Out-of-Network Coverage Gap

    You will be reimbursed for these drugs purchased out-of-network up to the plan's cost of the drug minus the following:

    Tier 1: Preferred Generic

    • $7 copay for a one-month (30-day) supply of certain drugs covered within this tier


    • Tier 2: Non-Preferred Generic

    • $12 copay for a one-month (30-day) supply of certain drugs covered within this tier


    • Tier 3: Preferred Brand

    • $45 copay for a one-month (30-day) supply of certain drugs covered within this tier


    • Tier 4: Non-Preferred Brand

    • $89 copay for a one-month (30-day) supply of certain drugs covered within this tier


    • Tier 5: Specialty Tier

    • 33% coinsurance for a one-month (30-day) supply of certain drugs covered within this tier


    Out-of-Network Catastrophic Coverage

    After your yearly out-of-pocket drug costs reach $4,550, you will be reimbursed for drugs purchased out-of-network up to the plan's cost of the drug minus your cost share, which is the greater of:
    • 5% coinsurance, or
    • $2.55 copay for generic (including brand drugs treated as generic) and a $6.35 copay for all other drugs.


    You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.


    Other Services

    Inpatient Care

    Doctor and Hospital Choice



    In-Network

    No referral required for network doctors, specialists, and hospitals.

    In and Out-of-Network

    You can go to doctors, specialists, and hospitals in or out of the network. It will cost more to get out of network benefits.

    Out of Service Area

    Plan covers you when you travel in the U.S. or its territories.


    Inpatient Hospital Care



    In-Network

    No limit to the number of days covered by the plan each hospital stay.

    For Medicare-covered hospital stays:

    • Days 1 - 6: $275 copay per day


    • Days 7 - 90: $0 copay per day


    $0 copay for each additional non-Medicare-covered hospital day.

    Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.

    Out-of-Network

    40% of the cost for each Medicare-covered hospital stay.


    Outpatient Care

    Inpatient Mental Health Care



    In-Network

    You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.

    $1,400 copay for each Medicare-covered hospital stay.

    Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.

    Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.

    Out-of-Network

    40% of the cost for each Medicare-covered hospital stay.


    Skilled Nursing Facility (SNF)



    General

    Authorization rules may apply.

    In-Network

    Plan covers up to 100 days each benefit period

    No prior hospital stay is required.

    For SNF stays:

    • Days 1 - 14: $0 copay per day


    • Days 15 - 21: $25 copay per day


    • Days 22 - 100: $150 copay per day


    Out-of-Network

    40% of the cost for each Medicare-covered SNF stay.


    Home Health Care



    General

    Authorization rules may apply.

    In-Network

    $0 copay for each Medicare-covered home health visit

    Out-of-Network

    20% of the cost for Medicare-covered home health visits


    Hospice



    General

    You must get care from a Medicare-certified hospice. You must consult with your plan before you select hospice.


    Doctor Office Visits



    In-Network

    $15 copay for each Medicare-covered primary care doctor visit.

    $40 copay for each Medicare-covered specialist visit.

    Out-of-Network

    40% of the cost for each Medicare-covered primary care doctor visit

    40% of the cost for each Medicare-covered specialist visit


    Outpatient Medical Services and Supplies

    Chiropractic Services



    General

    Authorization rules may apply.

    In-Network

    $20 copay for each Medicare-covered chiropractic visit

    Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part).

    Out-of-Network

    40% of the cost for Medicare-covered chiropractic visits.


    Podiatry Services



    General

    Authorization rules may apply.

    In-Network

    $40 copay for each Medicare-covered podiatry visit

    Medicare-covered podiatry visits are for medically necessary foot care.

    Out-of-Network

    40% of the cost for Medicare-covered podiatry visits


    Outpatient Mental Health Care



    General

    Authorization rules may apply.

    In-Network

    $40 copay for each Medicare-covered individual therapy visit

    $40 copay for each Medicare-covered group therapy visit

    $40 copay for each Medicare-covered individual therapy visit with a psychiatrist

    $40 copay for each Medicare-covered group therapy visit with a psychiatrist

    $40 copay for Medicare-covered partial hospitalization program services

    Out-of-Network

    40% of the cost for Medicare-covered Mental Health visits with a psychiatrist

    40% of the cost for Medicare-covered Mental Health visits

    40% of the cost for Medicare-covered partial hospitalization program services


    Outpatient Substance Abuse Care



    General

    Authorization rules may apply.

    In-Network

    $100 copay for Medicare-covered individual substance abuse outpatient treatment visits

    $100 copay for Medicare-covered group substance abuse outpatient treatment visits

    Out-of-Network

    40% of the cost for Medicare-covered substance abuse outpatient treatment visits


    Outpatient Services



    General

    Authorization rules may apply.

    In-Network

    $225 copay for each Medicare-covered ambulatory surgical center visit

    $50 to $275 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit

    Out-of-Network

    20% to 40% of the cost for Medicare-covered outpatient hospital facility visits

    40% of the cost for Medicare-covered ambulatory surgical center visits


    Ambulance Services



    General

    Authorization rules may apply.

    In-Network

    $250 copay for Medicare-covered ambulance benefits.

    Out-of-Network

    $250 copay for Medicare-covered ambulance benefits.


    Emergency Care



    General

    $65 copay for Medicare-covered emergency room visits

    Worldwide coverage.

    If you are admitted to the hospital within 24-hour(s) for the same condition, you pay $0 for the emergency room visit.


    Urgently Needed Care



    General

    40% of the cost for Medicare-covered urgently-needed-care visits


    Outpatient Rehabilitation Services



    General

    Authorization rules may apply.

    Medically necessary physical therapy, occupational therapy, and speech and language pathology services are covered.

    In-Network

    $60 copay for Medicare-covered Occupational Therapy visits

    $60 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits

    Out-of-Network

    40% of the cost for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits

    40% of the cost for Medicare-covered Occupational Therapy visits.


    Durable Medical Equipment



    General

    Authorization rules may apply.

    In-Network

    15% of the cost for Medicare-covered durable medical equipment

    You may pay less if you purchase these items from the plan's preferred manufacturers/vendors. Contact the plan for a list of non-preferred and preferred manufacturers/vendors.

    Out-of-Network

    25% of the cost for Medicare-covered durable medical equipment


    Preventive Services

    Prosthetic Devices



    General

    Authorization rules may apply.

    In-Network

    20% of the cost for Medicare-covered prosthetic devices

    20% of the cost for Medicare-covered medical supplies related to prosthetics, splints, and other devices

    Out-of-Network

    25% of the cost for Medicare-covered prosthetic devices.


    Diabetes Programs and Supplies



    General

    Authorization rules may apply.

    In-Network

    $0 copay for Medicare-covered Diabetes self-management training

    0% to 20% of the cost for Medicare-covered Diabetes monitoring supplies

    $10 copay for Medicare-covered Therapeutic shoes or inserts

    Out-of-Network

    25% of the cost for Medicare-covered Diabetes monitoring supplies

    25% of the cost for Medicare-covered Therapeutic shoes or inserts

    40% of the cost for Medicare-covered Diabetes self-management training


    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services



    General

    Authorization rules may apply.

    In-Network

    $0 to $100 copay for Medicare-covered lab services

    $0 to $100 copay for Medicare-covered diagnostic procedures and tests

    $15 to $100 copay for Medicare-covered X-rays

    $225 to $275 copay for Medicare-covered diagnostic radiology services (not including X-rays)

    $40 to $50 copay for Medicare-covered therapeutic radiology services

    Out-of-Network

    20% to 40% of the cost for Medicare-covered diagnostic procedures and tests

    40% of the cost for Medicare-covered therapeutic radiology services

    40% of the cost for Medicare-covered outpatient X-rays

    40% of the cost for Medicare-covered diagnostic radiology services

    40% of the cost for Medicare-covered lab services


    Cardiac and Pulmonary Rehabilitation Services



    General

    Authorization rules may apply.

    In-Network

    $40 to $100 copay for Medicare-covered Cardiac Rehabilitation Services

    $40 to $100 copay for Medicare-covered Intensive Cardiac Rehabilitation Services

    $40 to $100 copay for Medicare-covered Pulmonary Rehabilitation Services

    Out-of-Network

    40% of the cost for Medicare-covered Cardiac Rehabilitation Services

    40% of the cost for Medicare-covered Intensive Cardiac Rehabilitation Services

    40% of the cost for Medicare-covered Pulmonary Rehabilitation Services


    Additional Benefits

    Preventive Services



    General

    $0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.

    In-Network

    $0 copay for a supplemental annual physical exam

    Out-of-Network

    0% to 50% of the cost for Medicare-covered preventive services

    40% of the cost for a supplemental annual physical exam


    Kidney Disease and Conditions



    General

    Authorization rules may apply.

    In-Network

    0% to 20% of the cost for Medicare-covered renal dialysis

    $0 copay for Medicare-covered kidney disease education services

    Out-of-Network

    0% to 20% of the cost for Medicare-covered renal dialysis

    40% of the cost for Medicare-covered kidney disease education services


    Dental Services



    In-Network

    $40 copay for Medicare-covered dental benefits

    0% of the cost for up to 2 supplemental oral exam(s) every year

    0% of the cost for up to 2 supplemental cleaning(s) every year

    0% of the cost for up to 2 supplemental fluoride treatment(s) every year

    0% of the cost for up to 4 supplemental dental x-ray(s)

    Out-of-Network

    40% of the cost for Medicare-covered comprehensive dental benefits

    50% of the cost for supplemental preventive dental benefits

    50% to 55% of the cost for supplemental comprehensive dental benefits

    In and Out-of-Network

    Contact the plan for availability of additional supplemental in-network and out-of-network comprehensive dental benefits.


    Hearing Services



    General

    Authorization rules may apply.

    In-Network

    In general, supplemental routine hearing exams and hearing aids not covered.

    $40 copay for Medicare-covered diagnostic hearing exams

    Out-of-Network

    40% of the cost for Medicare-covered diagnostic hearing exams.


    Vision Services



    In-Network

    $0 to $40 copay for Medicare-covered exams to diagnose and treat diseases and conditions of the eye, including an annual glaucoma screening for people at risk

    $0 copay for up to 1 supplemental routine eye exam(s) every year

    $0 copay for one pair of Medicare-covered eyeglasses (lenses and frames) or contact lenses after cataract surgery.

    Out-of-Network

    $0 copay for supplemental routine eye exams

    $0 copay for Medicare-covered eyewear

    40% of the cost for Medicare-covered eye exams

    In and Out-of-Network

    $40 plan coverage limit for supplemental eye exams every year. This limit applies to both in-network and out-of-network benefits.


    Cost Sharing Information

    Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

    30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
    Tier 1: Preferred Generic$7 copay$7 copay$7 copay
    Tier 2: Non-Preferred Generic$12 copay$12 copay$12 copay
    Tier 3: Preferred Brand Name$45 copay$45 copay$45 copay
    Tier 4: Non-Preferred Brand Name$89 copay$89 copay$89 copay
    Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
    90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
    Tier 1: Preferred Generic$21 copay$21 copay$0 copay
    Tier 2: Non-Preferred Generic$36 copay$36 copay$0 copay
    Tier 3: Preferred Brand Name$135 copay$135 copay$125 copay
    Tier 4: Non-Preferred Brand Name$267 copay$267 copay$257 copay
    Tier 5: Specialty Tier

    CMS Ratings

    Staying healthy - screenings, tests and vaccines

    Breast cancer screening
    Not Rated
    Colorectal cancer screening
    Cholesterol screening for patients with heart disease
    Glaucoma testing
    Annual flu vaccine
    Pneumonia vaccine
    Improving or maintaining physical health
    Improving or maintaining mental health
    Monitoring physical ability
    Access to primary care doctor visits
    Adult BMI assessment

    Managing Chronic Conditions

    Care for older adults – medication review
    Not Rated
    Care for older adults – functional status assessment
    Not Rated
    Care for older adults – Pain screening
    Not Rated
    Osteoporosis management in women who had a fracture
    Diabetes care – eye exam
    Diabetes care – kidney disease monitoring
    Diabetes care – blood sugar controlled
    Diabetes care – cholesterol controlled
    Controlling blood pressure
    Rheumatoid arthritis management
    Improving bladder control
    Reducing the risk of falling
    Plan all-cause readmissions

    Ratings of Plan Responsiveness and Care

    Getting needed care
    Getting appointments and care quickly
    Customer service
    Overall rating of health care quality
    Overall rating of plan

    Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

    Complaints about the health plan
    Beneficiary access and performance problems
    Members choosing to leave the plan
    Plan makes timely decision about appeals
    Reviewing appeals decisions
    Call center – foreign language interpreter and TTY/TDD availability

    Physician Finder

    Physicians that accept HumanaChoice R5826-012 (Regional PPO) for Texas

    /
    ABEDIN, MOEEN
    1701 N LEE TREVINO DR
    EL PASO, TX 79936
    HALE, ANNE
    1440 GEORGE DIETER DR
    EL PASO, TX 79936
    HOFFER, THOMAS
    2400 TRAWOOD DR
    EL PASO, TX 79936
    REISTER, GARY
    2400 TRAWOOD DR
    EL PASO, TX 79936
    CALDERONI, HENRY
    1721 N LEE TREVINO DR
    EL PASO, TX 79936
    RESIGNATO, PAUL
    1722 N ZARAGOZA RD
    EL PASO, TX 79936
    AZARCON-SAMONTE, PATRICIA
    11544 VISTA DEL SOL DR
    EL PASO, TX 79936
    MARQUEZ-SMITH, TERESA
    11410 VISTA DEL SOL DR
    EL PASO, TX 79936
    NGUYEN, VIVIANNE
    7343 BLACK MESA DR
    EL PASO, TX 79911
    MCDONALD, DUNCAN
    11450 ROJAS DR
    EL PASO, TX 79936
    SRINGAM, YADAH
    11965 PELLICANO DR
    EL PASO, TX 79936
    AHMAD, SAMIR
    1600 N LEE TREVINO DR
    EL PASO, TX 79936
    IWALOYE, FEMI
    11163 LA QUINTA PL
    EL PASO, TX 79936
    RUFFIER, JOSE
    11365 MONTWOOD DR
    EL PASO, TX 79936
    FARRELL, MITCHELL
    1400 GEORGE DIETER DR
    EL PASO, TX 79936
    BASTON, CATHERINE
    515A W BUTLER RD
    GREENVILLE, SC 29607
    WONG, KA
    1400 GEORGE DIETER DR
    EL PASO, TX 79936
    WHITE, JEREMY
    4800 ALBERTA
    EL PASO, TX 79905
    BLANCAS, MOSES
    1721 N LEE TREVINO DR STE B
    EL PASO, TX 79936
    BAKER, NANNI
    11965 PELLICANO DR
    EL PASO, TX 79936
    GARCIA, BLANCA
    4801 ALBERTA AVE
    EL PASO, TX 79905
    HERNANDEZ, ARTURO
    2931 GEORGE DIETER DR
    EL PASO, TX 79936
    STEVENSON, EUGENE
    11165 LA QUINTA PLACE
    EL PASO, TX 79936
    MEDINA, IRMA
    11861 PHYSICIAN DR
    EL PASO, TX 79936
    WOJCIECHOWSKA, JOANNA
    11861 PHYSICIAN DR
    EL PASO, TX 79936
    Details
    MOEEN ABEDIN, M.D.
    Phone Number
    (915) 593-5999
    Office Locations
    1701 N LEE TREVINO DR
    EL PASO, TX 79936
    1701 N LEE TREVINO DR EL PASO TX, 79936

    Community Q&A

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