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

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
$6,700 In-Network$10,000 In and Out-of-Network
Other Deductibles?
In Network: Yes. 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 1-7: $250 copay per day. Days 8-90: $0 copay per day
30%
Inpatient Mental Health Care
Days 1-7: $200 copay per day. Days 8-90: $0 copay per day
30%
Skilled Nursing Facility (SNF)
Days 1-20: $25 copay per day. Days 21-100: $152 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
$100 maximum or 20% maximum per visit
$20 maximum or 30% maximum per visit
Ambulance Services
$225 maximum
$225 maximum
Emergency Care
$65 maximum per visit
Not Applicable
Durable Medical Equipment
15% 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
$20 maximum or 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.

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 - 7: $250 copay per day


  • Days 8 - 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 - 7: $200 copay per day


  • Days 8 - 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 - 20: $25 copay per day


  • Days 21 - 100: $152 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.

$10 to $35 copay for each Medicare-covered specialist visit.

Out-of-Network

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

$20 copay [or 30% of the cost] for each Medicare-covered specialist visit


Outpatient Medical Services and Supplies

Chiropractic Services



General

Authorization rules may apply.

In-Network

$15 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

$25 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 copay for Medicare-covered individual substance abuse outpatient treatment visits

$25 copay 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

$100 copay for each Medicare-covered ambulatory surgical center visit

$10 to $100 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit

Out-of-Network

$20 copay [or 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

$225 copay for Medicare-covered ambulance benefits.

Out-of-Network

$225 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

$35 copay for Medicare-covered urgently-needed-care visits

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

$50 copay for Medicare-covered Occupational Therapy visits

$50 copay 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

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

30% of the cost for Medicare-covered durable medical equipment


Preventive Services

Prosthetic Devices



General

Authorization rules may apply.

In-Network

15% of the cost for Medicare-covered prosthetic devices

15% 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

0% of the cost 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 $50 copay for Medicare-covered lab services

$0 to $50 copay for Medicare-covered diagnostic procedures and tests

$15 to $50 copay for Medicare-covered X-rays

$15 to $50 copay 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 diagnostic radiology services

$35 copay [or 30% of the cost] for Medicare-covered outpatient X-rays

$35 copay [or 30% of the cost] for Medicare-covered diagnostic procedures and tests

$35 copay [or 30% of the cost] for Medicare-covered lab services


Cardiac and Pulmonary Rehabilitation Services



General

Authorization rules may apply.

In-Network

$20 to $25 copay for Medicare-covered Cardiac Rehabilitation Services

$20 to $25 copay for Medicare-covered Intensive Cardiac Rehabilitation Services

$20 to $25 copay 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 30% 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

20% of the cost for Medicare-covered renal dialysis

$0 copay for Medicare-covered kidney disease education services

Out-of-Network

20% of the cost for Medicare-covered renal dialysis

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


Dental Services



In-Network

This plan covers some preventive dental benefits for an extra cost (see "Optional Supplemental Benefits.")

$35 copay for Medicare-covered dental benefits

Out-of-Network

30% of the cost for Medicare-covered 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

30% of the cost for Medicare-covered eye exams

30% of the cost for Medicare-covered eyewear

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 R5826-070 P (Regional PPO) for Arizona

/
EUBANKS, TAJ
830 W PEACHTREE ST NW
ATLANTA, GA 30308
KHONA, RAJESH
2400 S AVENUE A
YUMA, AZ 85364
ROJAS, TIRSO
2400 S AVE A
YUMA, AZ 85364
NACHIAPPAN, MUTHIA
2400 S AVE A
YUMA, AZ 85364
PATEL, KITA
2400 S AVE A
YUMA, AZ 85364
KEMMOU, AHMED
1841 W 25TH ST STE C
YUMA, AZ 85364
DAS, SUGATA
1965 W 24TH ST
YUMA, AZ 85364
LEWIS, TERRY
2189 S AVENUE A
YUMA, AZ 85364
CARROLL, BRENDA
1320 W 24TH ST
YUMA, AZ 85364
MOOR, CHRISTOPHER
1881 W 24TH ST
YUMA, AZ 85364
NATHAN, MANJUNATH
2095 W 24TH ST
YUMA, AZ 85364
DONIPARTHI, CHANDRASEKHAR
2400 S AVENUE A
YUMA, AZ 85364
CORIANO, RUBEN
682 S 4TH AVE
YUMA, AZ 85364
ANDERSON, STEVEN
2140 W 24TH ST
YUMA, AZ 85364
LUTHRA, CHAMAN
2325 S AVENUE A
YUMA, AZ 85364
LUTHRA, ADARSH
2325 S AVENUE A
YUMA, AZ 85364
MERI, BASEM
2851 S AVE B
YUMA, AZ 85364
LOKAREDDY, SURENDHER
1945 W 24TH ST
YUMA, AZ 85364
SOLIMAN, MOHAMMAD
1763 W 24TH ST
YUMA, AZ 85364
URIBE, CONSTANCE
2244 S AVE A
YUMA, AZ 85364
CARDENAS, JOSEPH
1975 W 24TH ST
YUMA, AZ 85364
MEJIA, ALBERTO
1975 W 24TH ST
YUMA, AZ 85364
LEWIS, JOHN
2149 W 24TH ST
YUMA, AZ 85364
HIEB, LEE
2051 W 25TH ST
YUMA, AZ 85364
WONG, DOROTHY
1025 W 24TH ST
YUMA, AZ 85364
Details
TAJ EUBANKS, M.D.
Phone Number
(404) 376-3639
Office Locations
830 W PEACHTREE ST NW
ATLANTA, GA 30308
830 W PEACHTREE ST NW ATLANTA GA, 30308

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.

Similar Plans

PremiumPlan NameCMS Rating
$180.00
Humana Gold Choice H8145-103 (PFFS)
Select
$12.80
WellCare Classic (PDP)
Select
$14.90
Blue Cross MedicareRx Basic (PDP)
Select
$0.00
UnitedHealthcare MedicareDirect Rx (PFFS)
Select
$0.00
CareMore Value Plus (HMO)
Select

Related Articles

Related Searches