PARTC

Plan Summary

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

What To Know About This Plan

  • This is a health coverage only plan with no drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2014
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
No
Out-Of-Pocket Spending Limit
$3,400 In-Network$5,100 In and Out-of-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
Not Applicable
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Inpatient Hospital Care
Days 1-9: $225 copay per day. Days 10-90: $0 copay per day
30%
Inpatient Mental Health Care
Days 1-9: $195 copay per day. Days 10-90: $0 copay per day
30%
Skilled Nursing Facility (SNF)
Days 1-14: $0 copay per day. Days 15-21: $50 copay per day. Days 22-100: $125 copay per day
30%
Home Health Care
$0 maximum per visit
30% maximum per visit
Doctor Office Visits
$15 maximum per visit
30% maximum per visit
Outpatient Services
25% maximum per visit
30% maximum per visit
Ambulance Services
20% maximum
20% maximum
Emergency Care
$65 maximum per visit
Not Applicable
Durable Medical Equipment
20% maximum per item
30% maximum per item
Kidney Disease and Conditions
20% maximum per visit
20% maximum per visit
Specialist Office Visit
$35 maximum per visit
30% maximum per visit

Prescription Drug Coverage

Drugs Covered under Medicare Part B

General

Most drugs not covered.

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

20% to 30% of the cost for Medicare Part B drugs out-of-network.


Drugs Covered under Medicare Part D

General

This plan does not offer prescription drug coverage.


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 - 9: $225 copay per day


  • Days 10 - 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

30% 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.

For Medicare-covered hospital stays:

  • Days 1 - 9: $195 copay per day


  • Days 10 - 90: $0 copay per day


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

30% 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: $50 copay per day


  • Days 22 - 100: $125 copay per day


Out-of-Network

30% 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

30% 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.

$35 copay for each Medicare-covered specialist visit.

Out-of-Network

30% of the cost for each Medicare-covered primary care doctor visit

30% 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

30% of the cost for Medicare-covered chiropractic visits.


Podiatry Services



General

Authorization rules may apply.

In-Network

$35 copay for each Medicare-covered podiatry visit

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

Out-of-Network

30% of the cost for Medicare-covered podiatry visits


Outpatient Mental Health Care



General

Authorization rules may apply.

In-Network

$35 copay for each Medicare-covered individual therapy visit

$35 copay for each Medicare-covered group therapy visit

$35 copay for each Medicare-covered individual therapy visit with a psychiatrist

$35 copay for each Medicare-covered group therapy visit with a psychiatrist

$35 copay for Medicare-covered partial hospitalization program services

Out-of-Network

30% of the cost for Medicare-covered Mental Health visits with a psychiatrist

30% of the cost for Medicare-covered Mental Health visits

30% of the cost for Medicare-covered partial hospitalization program services


Outpatient Substance Abuse Care



General

Authorization rules may apply.

In-Network

25% of the cost for Medicare-covered individual substance abuse outpatient treatment visits

25% of the cost for Medicare-covered group substance abuse outpatient treatment visits

Out-of-Network

30% of the cost for Medicare-covered substance abuse outpatient treatment visits


Outpatient Services



General

Authorization rules may apply.

In-Network

20% of the cost for each Medicare-covered ambulatory surgical center visit

20% to 25% of the cost for each Medicare-covered outpatient hospital facility visit

Out-of-Network

20% to 30% of the cost for Medicare-covered outpatient hospital facility visits

30% of the cost for Medicare-covered ambulatory surgical center visits


Ambulance Services



General

Authorization rules may apply.

In-Network

20% of the cost for Medicare-covered ambulance benefits.

Out-of-Network

20% of the cost 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

30% 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

$35 copay [or 25% of the cost] for Medicare-covered Occupational Therapy visits

$35 copay [or 25% of the cost] for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits

Out-of-Network

30% of the cost for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits

30% of the cost for Medicare-covered Occupational Therapy visits.


Durable Medical Equipment



General

Authorization rules may apply.

In-Network

20% 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

30% 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

30% 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

30% of the cost for Medicare-covered Diabetes self-management training

30% of the cost for Medicare-covered Diabetes monitoring supplies

30% of the cost for Medicare-covered Therapeutic shoes or inserts


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



General

Authorization rules may apply.

In-Network

$0 to $35 copay [or 25% of the cost] for Medicare-covered lab services

$0 to $35 copay [or 20% to 25% of the cost] for Medicare-covered diagnostic procedures and tests

$15 to $35 copay [or 20% to 25% of the cost] for Medicare-covered X-rays

$175 copay [or 20% to 25% of the cost] for Medicare-covered diagnostic radiology services (not including X-rays)

$35 copay [or 20% of the cost] for Medicare-covered therapeutic radiology services

Out-of-Network

30% of the cost for Medicare-covered therapeutic radiology services

30% of the cost for Medicare-covered outpatient X-rays

30% of the cost for Medicare-covered diagnostic radiology services

30% of the cost for Medicare-covered diagnostic procedures and tests

30% of the cost for Medicare-covered lab services


Cardiac and Pulmonary Rehabilitation Services



General

Authorization rules may apply.

In-Network

$35 copay [or 25% of the cost] for Medicare-covered Cardiac Rehabilitation Services

$35 copay [or 25% of the cost] for Medicare-covered Intensive Cardiac Rehabilitation Services

$35 copay [or 25% of the cost] for Medicare-covered Pulmonary Rehabilitation Services

Out-of-Network

30% of the cost for Medicare-covered Cardiac Rehabilitation Services

30% of the cost for Medicare-covered Intensive Cardiac Rehabilitation Services

30% 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

30% 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

30% of the cost for Medicare-covered kidney disease education services


Dental Services



In-Network

$35 copay for Medicare-covered dental benefits

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

$0 copay for up to 1 supplemental cleaning(s) every year

$0 copay for up to 1 supplemental dental x-ray(s) every year

Out-of-Network

30% of the cost for Medicare-covered comprehensive dental benefits

50% of the cost for supplemental comprehensive dental benefits

50% of the cost for supplemental preventive 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.

$35 copay for Medicare-covered diagnostic hearing exams

Out-of-Network

30% of the cost for Medicare-covered diagnostic hearing exams.


Vision Services



In-Network

$0 to $35 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

30% 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.


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 R5826-069 (Regional PPO) for Kansas

/
HARRIS, GARY
15435 W 134TH PL
OLATHE, KS 66062
CHARTRAND, KATHRYN
18695 W 151ST ST
OLATHE, KS 66062
KOHLER, LINDA
1925 E WILLOW DR
OLATHE, KS 66062
MATTESON, CHARLIE
15435 W 134TH PL
OLATHE, KS 66062
MCNEARNEY, MICHAEL
13917 S KAW ST
OLATHE, KS 66062
PATEL, K
601 N MUR LEN RD
OLATHE, KS 66062
FARAHANI, MAHDOKHT
2141 E 151ST ST
OLATHE, KS 66062
Details
GARY HARRIS, MD
Phone Number
(913) 780-0030
Office Locations
15435 W 134TH PL
OLATHE, KS 66062
15435 W 134TH PL OLATHE KS, 66062

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