PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Humana
CMS Rating
Plan Type
Regional PPO
Annual Deductible
$360.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium
  • 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?
No
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$10,000 In and Out-of-network $6,700 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$975 annual deductible
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

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: $60 copay

  • Specialist visit:
  • In-network: $50 copay

  • Out-of-network: $60 copay
  • 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: 50% 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:

  • $390 copay per day for days 1 through 4

  • You pay nothing per day for days 5 through 90

  • Out-of-network:

  • $495 copay per day for days 1 through 27

  • You pay nothing per day for days 28 through 90

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

  • Out-of-network: $60 copay

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

  • Out-of-network: $60 copay

  • You pay this amount each time you are admitted or transferred to a
    facility.
    Outpatient hospital
    In-network: $390 per visit
    Out-of-network: 50% per visit
    Renal dialysis
    In-network: 20% per visit
    Out-of-network: 20% per visit
    Inpatient Hospital Care
    In-network: $425 for days 1 through 4
    $0 for days 5 through 90
    $0 for days 91 and beyond
    Out-of-network: $495 for days 1 through 27
    $0 for days 28 through 90
    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: $60 copay
  • Dental Services
    Limited dental services (this does not include services in connection
    with care, treatment, filling, removal, or replacement of teeth):
  • In-network: $50 copay

  • Out-of-network: $60 copay

  • 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 1 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: 50% of the cost

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

  • Out-of-network: 50% of the cost

  • Therapeutic shoes or inserts:
  • In-network: You pay nothing

  • Out-of-network: 50% 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: $50-350 copay, depending on the service

  • Out-of-network: $60-275 copay or 50% of the cost, depending on

  • the service
    Diagnostic tests and procedures:
  • In-network: $0-290 copay, depending on the service

  • Out-of-network: $60 copay or 50% of the cost, depending on the

  • service
    Lab services:
  • In-network: $0-290 copay, depending on the service

  • Out-of-network: $60 copay or 50% of the cost, depending on the

  • service
    Outpatient x-rays:
  • In-network: $15-290 copay, depending on the service

  • Out-of-network: $60 copay or 50% of the cost, depending on the

  • service
    Therapeutic radiology services (such as radiation treatment for
    cancer):
  • In-network: $50 copay or 20% of the cost, depending on the

  • service
  • Out-of-network: $60 copay or 50% of the cost, depending on the

  • service
    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: $50 copay

  • Out-of-network: $60 copay
  • 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: $50 copay

  • Out-of-network: $60 copay or 50% of the cost, depending on the

  • service
    Occupational therapy visit:
  • In-network: $10-40 copay, depending on the service

  • Out-of-network: $60 copay or 50% of the cost, depending on the

  • service
    Physical therapy and speech and language therapy visit:
  • In-network: $10-40 copay, depending on the service

  • Out-of-network: $60 copay or 50% of the cost, depending on the

  • service
  • In-Network

  • Cardiac Therapy Rehabilitation

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

  • – Specialist: $10 copayment
    – Outpatient: $40 copayment
    – Comprehensive Outpatient Rehab: $10 copayment
    Outpatient Substance Abuse
    Group therapy visit:
  • In-network: $40-290 copay, depending on the service

  • Out-of-network: $60 copay or 50% of the cost, depending on the

  • service
    Individual therapy visit:
  • In-network: $40-290 copay, depending on the service

  • Out-of-network: $60 copay or 50% of the cost, depending on the

  • service
  • In-Network:

  • $290 copayment Outpatient hospital

  • $50 copayment Partial hospitalization

  • $40 copayment Specialist's Office

  • Out-of-Network:

  • 50% coinsurance Outpatient hospital

  • 50% coinsurance Partial hospitalization

  • $60 copayment Specialist's Office
  • Outpatient Surgery
    Ambulatory surgical center:
  • In-network: $350 copay

  • Out-of-network: 50% of the cost

  • Outpatient hospital:
  • In-network: $390 copay

  • Out-of-network: 50% of the cost
  • Over-the-Counter Items
    Not Covered
    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: $0-50 copay, depending on the service

  • Out-of-network: $60 copay or 50% of the cost, depending on the

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

  • Out-of-network: $0 copay

  • Our plan pays up to $75 every year for routine eye exams from any
    provider.
    Contact lenses (for up to 1 every year):
  • In-network: $0 copay

  • Out-of-network: $0 copay

  • Eyeglasses (frames and lenses) (for up to 1 every year):
  • In-network: $0 copay

  • Out-of-network: $0 copay

  • Eyeglasses or contact lenses after cataract surgery:
  • In-network: You pay nothing

  • Out-of-network: You pay nothing

  • Our plan pays up to $200 every year for contact lenses and
    eyeglasses (frames and lenses) from any provider.
    You pay nothing up to the $200 allowance every year.
    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:

  • $425 copay per day for days 1 through 4

  • You pay nothing per day for days 5 through 90

  • You pay nothing per day for days 91 and beyond

  • Out-of-network:

  • $495 copay per day for days 1 through 27

  • You pay nothing per day for days 28 through 90

  • You pay this amount each time you are admitted or transferred to a
    facility.
    Durable Medical Equipment
  • In-network: 20% of the cost

  • Out-of-network: 30% 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: $50 copay

  • Out-of-network: $60 copay
  • Urgent Care
    $15-60 copay or 50% of the cost (up to $65), depending on the
    service
  • In-network:

  • $15 copayment Primary care

  • $50 copayment Specialist's office

  • $50 copayment urgent care center

  • Out-of-Network:

  • $60 copayment Primary care

  • $60 copayment Specialist's office

  • 50% 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

  • $150 copay per day for days 21 through 100

  • Out-of-network:

  • $250 copay per day for days 1 through 58

  • You pay nothing per day for days 59 through 100
  • 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$17 copay$17 copay$17 copay
    Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay
    Tier 4: Non-Preferred Brand Name$97 copay$97 copay$97 copay
    Tier 5: Specialty Tier25% coinsurance25% coinsurance25% 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$51 copay$51 copay$0 copay
    Tier 3: Preferred Brand Name$141 copay$141 copay$131 copay
    Tier 4: Non-Preferred Brand Name$291 copay$291 copay$281 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 R5826-074 (Regional PPO) for Florida

    /
    GENAO, ESTEBAN
    13059 SW 112TH ST
    MIAMI, FL 33186
    SCHNEIDER, JESSICA
    12608 SW 88TH ST
    MIAMI, FL 33186
    CALAFELL, YESIM
    14261 SW 120TH STREET
    MIAMI, FL 33186
    MCCARTHY, LIAM
    11801 SW 90TH ST
    MIAMI, FL 33186
    GARCIA-ORTIZ, SANDRA
    11435 SW 133RD CT APT 3
    MIAMI, FL 33186
    HERNANDEZ, OSCAR
    14221 SW 120TH ST
    MIAMI, FL 33186
    ESPINOSA, CARMEN
    13550 SW 88TH STREET STE 280
    MIAMI, FL 33186
    VAZQUEZ, NELSON
    13500 SW 88 ST
    KENDALL, FL 33186
    JIMENEZ, MILTON
    12002 SW 128TH CT STE 204
    MIAMI, FL 33186
    JARRETT, WENTWORTH
    12955 SW 132ND ST
    MIAMI, FL 33186
    NUNEZ, RIGOBERTO
    8900 SW 117TH AVE
    MIAMI, FL 33186
    PONS, FRANCISCO
    13500 SW 88TH ST
    MIAMI, FL 33186
    SHAH, CHANDRAKANT
    13033 SW 112TH ST
    MIAMI, FL 33186
    RAJADHYAKSHA, AMAR
    11801 SW 90TH ST
    MIAMI, FL 33186
    CINTAS, MAURA
    9000 SW 137TH AVE
    MIAMI, FL 33186
    RODICIO, ILEANA
    9000 SW 137TH AVE
    MIAMI, FL 33186
    MAYORGA, RENE
    14261 SW 120TH ST STE 110
    MIAMI, FL 33186
    BUIA, MONTSERRAT
    11801 SW 90TH ST
    MIAMI, FL 33186
    NEELY, MICHELLE
    13500 SW 88TH ST
    MIAMI, FL 33186
    CRUZ, FRANCISCO
    13500 N KENDALL DR
    MIAMI, FL 33186
    GOYKHMAN, GARY
    11801 SW 90TH ST
    MIAMI, FL 33186
    GUPTA, PADMA
    13500 SW 88TH ST
    MIAMI, FL 33186
    GOMEZ, MANUEL
    13000 SW 117 STREET
    MIAMI, FL 33186
    MAFUT, DAMARIS
    14451 COUNTRY WALK DR
    MIAMI, FL 33186
    GERSTEN, JANET
    8900 SW 117TH AVE
    MIAMI, FL 33186
    Details
    ESTEBAN GENAO, MD FAAP
    Phone Number
    (305) 387-2060
    Office Locations
    13059 SW 112TH ST
    MIAMI, FL 33186
    13059 SW 112TH ST MIAMI FL, 33186

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