PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Humana
CMS Rating
Plan Type
Regional PPO
Annual Deductible
$200.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • gives you freedom to choose which doctors, specialist and hospitals you visit

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$9,000 In and Out-of-network $6,700 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$750 annual deductible
Monthly Drug Plan Premium
$37.20
Monthly Health Plan Premium
$34.80

Benefits

Service
Cost
Ambulance Services
  • In-network: $300 copay

  • Out-of-network: $300 copay
  • Doctors Office Visits
    Primary care physician visit:
  • In-network: $15 copay

  • Out-of-network: 40% of the cost

  • Specialist visit:
  • In-network: $45 copay

  • Out-of-network: 40% of the cost
  • Emergency Care
    $75 copay
    If you are admitted to the hospital within 24 hours, you do not have
    to pay your share of the cost for emergency care. See the "Inpatient
    Hospital Care" section of this booklet for other costs.
    Home Health Care
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost
  • Mental Health Care
    Inpatient visit:
    Our plan covers up to 190 days in a lifetime for inpatient mental
    health care in a psychiatric hospital. The inpatient hospital care limit
    does not apply to inpatient mental services provided in a general
    hospital.
    Our plan covers 90 days for an inpatient hospital stay.
    Our plan also covers 60 "lifetime reserve days." These are "extra" days
    that we cover. If your hospital stay is longer than 90 days, you can
    use these extra days. But once you have used up these extra 60 days,
    your inpatient hospital coverage will be limited to 90 days.
  • In-network:

  • $300 copay per day for days 1 through 5

  • You pay nothing per day for days 6 through 90

  • Out-of-network:

  • 40% of the cost per stay

  • Outpatient group therapy visit:
  • In-network: $40 copay

  • Out-of-network: 40% of the cost

  • Outpatient individual therapy visit:
  • In-network: $40 copay

  • Out-of-network: 40% of the cost

  • You pay this amount each time you are admitted or transferred to a
    facility.
    Outpatient hospital
    In-network: $325 per visit
    Out-of-network: 40% per visit
    Renal dialysis
    In-network: 20% per visit
    Out-of-network: 20% per visit
    Inpatient Hospital Care
    In-network: $325 for days 1 through 5
    $0 for days 6 through 90
    $0 for days 91 and beyond
    Out-of-network: 40% per stay
    Acupuncture
    Not covered
    Chiropractic Care
    Manipulation of the spine to correct a subluxation (when 1 or more of
    the bones of your spine move out of position):
  • In-network: $20 copay

  • Out-of-network: 40% of the cost
  • Dental Services
    Limited dental services (this does not include services in connection
    with care, treatment, filling, removal, or replacement of teeth):
  • In-network: $45 copay

  • Out-of-network: 40% of the cost

  • Preventive dental services:
    Cleaning (for up to 2 every year):
  • In-network: You pay nothing

  • Out-of-network: 50% of the cost

  • Dental x-ray(s) (for up to 4):
  • In-network: You pay nothing

  • Out-of-network: 50% of the cost

  • Fluoride treatment (for up to 2 every year):
  • In-network: You pay nothing

  • Out-of-network: 50% of the cost

  • Oral exam (for up to 2 every year):
  • In-network: You pay nothing

  • Out-of-network: 50% of the cost

  • Additional benefits are covered by your plan. For detailed benefit
    information please call the Customer Care number listed in the
    “Things To Know About Your Plan” section above.
    Diabetes Supplies and Services
    Diabetes monitoring supplies:
  • In-network: 0-20% of the cost, depending on the supply

  • Out-of-network: 25% of the cost

  • Diabetes self-management training:
  • In-network: You pay nothing

  • Out-of-network: 40% of the cost

  • Therapeutic shoes or inserts:
  • In-network: $10 copay

  • Out-of-network: 25% of the cost
  • Diagnostic Tests, Lab and Radiology Services, and X-Rays (Costs for these services may be different if received in an outpatient surgery setting)
    Diagnostic radiology services (such as MRIs, CT scans):
  • In-network: $45-325 copay, depending on the service

  • Out-of-network: 40% of the cost

  • Diagnostic tests and procedures:
  • In-network: $0-100 copay, depending on the service

  • Out-of-network: 20-40% of the cost, depending on the service

  • Lab services:
  • In-network: $0-100 copay, depending on the service

  • Out-of-network: 40% of the cost

  • Outpatient x-rays:
  • In-network: $15-100 copay, depending on the service

  • Out-of-network: 40% of the cost

  • Therapeutic radiology services (such as radiation treatment for
    cancer):
  • In-network: $45 copay or 20% of the cost, depending on the

  • service
  • Out-of-network: 40% of the cost

  • The copay depends on where the service is provided.
    Please call Customer Care for further details.
    Hearing Services
    Exam to diagnose and treat hearing and balance issues:
  • In-network: $45 copay

  • Out-of-network: 40% of the cost
  • Outpatient Rehabilitation
    Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions
    per day for up to 36 sessions up to 36 weeks):
  • In-network: $40-50 copay, depending on the service

  • Out-of-network: 40% of the cost

  • Occupational therapy visit:
  • In-network: $25 copay

  • Out-of-network: 40% of the cost

  • Physical therapy and speech and language therapy visit:
  • In-network: $25 copay

  • Out-of-network: 40% of the cost

  • In-Network

  • Cardiac Therapy Rehabilitation

  • – Specialist: $40 copayment
    – Outpatient: $50 copayment
  • Occupational, Physical, Speech Therapy

  • – Specialist: $25 copayment
    – Outpatient: $25 copayment
    – Comprehensive Outpatient Rehab: $25 copayment
    Outpatient Substance Abuse
    Group therapy visit:
  • In-network: $40-100 copay, depending on the service

  • Out-of-network: 40% of the cost

  • Individual therapy visit:
  • In-network: $40-100 copay, depending on the service

  • Out-of-network: 40% of the cost

  • In-Network:

  • $100 copayment Outpatient hospital

  • $45 copayment Partial hospitalization

  • $40 copayment Specialist's Office

  • Out-of-Network:

  • 40% coinsurance Outpatient hospital

  • 40% coinsurance Partial hospitalization

  • 40% coinsurance Specialist's Office
  • Outpatient Surgery
    Ambulatory surgical center:
  • In-network: $225 copay

  • Out-of-network: 40% of the cost

  • Outpatient hospital:
  • In-network: $325 copay

  • Out-of-network: 40% of the cost
  • Over-the-Counter Items
    Please visit our website to see our list of covered over-the-counter
    items.
    – You are eligible to receive a $25 monthly benefit toward the
    purchase of selected over-the-counter items when you use
    Humana's mail order service.
    – For more information or to request an order form, please call
    Customer Care.
    Renal Dialysis
  • In-network: 20% of the cost

  • Out-of-network: 20% of the cost
  • Transportation
    Not covered
    Vision Services
    Exam to diagnose and treat diseases and conditions of the eye
    (including yearly glaucoma screening):
  • In-network: $0-45 copay, depending on the service

  • Out-of-network: 40% of the cost

  • Routine eye exam (for up to 1 every year):
  • In-network: $0 copay

  • Out-of-network: $0 copay

  • Our plan pays up to $40 every year for routine eye exams from any
    provider.
    Eyeglasses or contact lenses after cataract surgery:
  • In-network: You pay nothing

  • Out-of-network: You pay nothing
  • Preventive Care
  • In-network: You pay nothing

  • Out-of-network: 0-50% of the cost, depending on the service

  • Our plan covers many preventive services, including:
  • Abdominal aortic aneurysm screening

  • Alcohol misuse counseling

  • Bone mass measurement

  • Breast cancer screening (mammogram)

  • Cardiovascular disease (behavioral therapy)

  • Cardiovascular screenings

  • Cervical and vaginal cancer screening

  • Colorectal cancer screenings (Colonoscopy, Fecal occult blood

  • test, Flexible sigmoidoscopy)
  • Depression screening

  • Diabetes screenings

  • HIV screening

  • Medical nutrition therapy services

  • Obesity screening and counseling

  • Prostate cancer screenings (PSA)

  • Sexually transmitted infections screening and counseling

  • Tobacco use cessation counseling (counseling for people with

  • no sign of tobacco-related disease)
  • Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal

  • shots
  • "Welcome to Medicare" preventive visit (one-time)

  • Yearly "Wellness" visit

  • Any additional preventive services approved by Medicare during the
    contract year will be covered.
    Hospice
    You pay nothing for hospice care from a Medicare-certified hospice.
    You may have to pay part of the costs for drugs and respite care.
    Hospice is covered outside of our plan. Please contact us for more
    details.
    INPATIENT CARE Inpatient Hospital Care
    Our plan covers an unlimited number of days for an inpatient hospital
    stay.
  • In-network:

  • $325 copay per day for days 1 through 5

  • You pay nothing per day for days 6 through 90

  • You pay nothing per day for days 91 and beyond

  • Out-of-network:

  • 40% of the cost per stay

  • You pay this amount each time you are admitted or transferred to a
    facility.
    Durable Medical Equipment
  • In-network: 15% of the cost

  • Out-of-network: 25% of the cost

  • If you go to a preferred vendor, your cost may be less. Contact us for a
    list of preferred vendors.
    Foot Care
    Foot exams and treatment if you have diabetes-related nerve
    damage and/or meet certain conditions:
  • In-network: $45 copay

  • Out-of-network: 40% of the cost
  • Urgent Care
    $15-45 copay or 40% of the cost (up to $65), depending on the
    service
  • In-network:

  • $15 copayment Primary care

  • $45 copayment Specialist's office

  • $35 copayment urgent care center

  • Out-of-Network:

  • 40% coinsurance Primary care

  • 40% coinsurance Specialist's office

  • 40% coinsurance urgent care center
  • Skilled Nursing Facility
    Our plan covers up to 100 days in a SNF.
  • In-network:

  • You pay nothing per day for days 1 through 20

  • $160 copay per day for days 21 through 100

  • Out-of-network:

  • 40% of the cost per stay
  • Prosthetic Devices
    Prosthetic devices:
  • In-network: 20% of the cost

  • Out-of-network: 25% of the cost

  • Related medical supplies:
  • In-network: 20% of the cost

  • Out-of-network: 25% of the cost
  • 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$47 copay$47 copay$47 copay
    Tier 4: Non-Preferred Brand Name$99 copay$99 copay$99 copay
    Tier 5: Specialty Tier28% coinsurance28% coinsurance28% 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$141 copay$141 copay$131 copay
    Tier 4: Non-Preferred Brand Name$297 copay$297 copay$287 copay
    Tier 5: Specialty Tier

    CMS Ratings

    Staying healthy - screenings, tests and vaccines

    Breast cancer screening
    Colorectal cancer screening
    Annual flu vaccine
    Improving or maintaining physical health
    Improving or maintaining mental health
    Monitoring physical ability
    Adult BMI assessment

    Managing Chronic Conditions

    Special needs plan care management
    Not Rated
    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
    Controlling blood pressure
    Rheumatoid arthritis management
    Reducing the risk of falling
    Plan all-cause readmissions

    Member Experience with Health Plan

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

    Member Complaints, and Changes in Health Plan's Performance

    Complaints about the health plan
    Members choosing to leave the health plan
    Beneficiary access and performance problems
    Health plan quality improvement

    Health Plan Customer Service

    Plan makes timely decision about appeals
    Reviewing appeals decisions
    Call center – foreign language interpreter and TTY/TDD availability - Medical

    Drug Plan Customer Service

    Call center – foreign language interpreter and TTY/TDD availability - Drugs
    Appeals auto-forward
    Appeals upheld

    Member Complaints, and Changes in Drug Plan's Performance

    Complaints about the drug plan
    Members choosing to leave the drug plan
    Beneficiary access and performance problems
    Drug plan quality improvement

    Member Experience with Drug Plan

    Rating of drug plan
    Getting needed prescription drugs

    Drug Pricing and Patient Safety

    MPF Price Accuracy
    High risk medication
    Part D medication adherence for diabetes
    Part D medication adherence for hypertension
    Part D medication adherence for cholesterol
    Medication Therapy Management program completion rate

    Physician Finder

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

    /
    MARQUEZ, RICARDO
    1421 N LEE TREVINO DR
    EL PASO, TX 79936
    BLANCAS, MOSES
    1721 N LEE TREVINO DR STE B
    EL PASO, TX 79936
    RESIGNATO, PAUL
    1722 N ZARAGOZA RD
    EL PASO, TX 79936
    LAZARO, SHELLEY
    1512 N ZARAGOZA RD
    EL PASO, TX 79936
    GROSS, ERIC
    11163 LA QUINTA PL
    EL PASO, TX 79936
    HALE, ANNE
    1440 GEORGE DIETER DR
    EL PASO, TX 79936
    ABEDIN, ZAINUL
    1701 N LEE TREVINO DR
    EL PASO, TX 79936
    KANKONDE, MUTOMBO
    11601 PELLICANO DR
    EL PASO, TX 79936
    GILARDONI, PAUL
    1416 GEORGE DIETER DR
    EL PASO, TX 79936
    FARRELL, MITCHELL
    1400 GEORGE DIETER DR
    EL PASO, TX 79936
    BARAHONA, JOSE
    11355 MONTWOOD DR
    EL PASO, TX 79936
    REYNOLDS, BRIAN
    11950 BOB MITCHELL DR
    EL PASO, TX 79936
    LIANO, RUBEN
    11450 ROJAS DR STE D1
    EL PASO, TX 79936
    MCDONALD, DUNCAN
    11450 ROJAS DR
    EL PASO, TX 79936
    LAZAR, GABRIEL
    1635 N LEE TREVINO DR STE C
    EL PASO, TX 79936
    SEBESTA, MICHAEL
    3100 N LEE TREVINO DR STE G
    EL PASO, TX 79936
    KHATEEB, MAZIN
    3235 TRAWOOD DR.
    EL PASO, TX 79936
    ZERBACH, KATHRYN
    1400 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
    CHAVEZ-RICE, EUGENIO
    1514 N ZARAGOZA RD
    EL PASO, TX 79936
    JOSEPH-VANDERPOOL, JEAN
    1514 ZARAGOSA
    EL PASO, TX 79936
    SANDBERG, KEVIN
    1393 GEORGE DIETER DR
    EL PASO, TX 79936
    PARRILLA, ZORAYA
    1393 GEORGE DIETER DR STE A
    EL PASO, TX 79936
    ORTIZ, JORGE
    11400 VISTA DEL SOL DR
    EL PASO, TX 79936
    Details
    RICARDO MARQUEZ, D.D.S.
    Phone Number
    (915) 593-1328
    Office Locations
    1421 N LEE TREVINO DR
    EL PASO, TX 79936
    1421 N LEE TREVINO DR EL PASO TX, 79936

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