2019 HumanaChoice R5361-002 (Regional PPO) R5361-002-000 in IL from Humana | HealthPocket

HumanaChoice R5361-002 (Regional PPO)

$117/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDR5361-002-000
Plan Year2019
CMS Rating
Plan TypeRegional PPO
Annual Deductible$390.00
Out-of-Pocket Maximum6700

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2021. see plan

Why We Like This Plan
  • has both Health and Drug Coverage

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$89.20
Monthly Drug Plan Premium$27.80
Health Plan Deductible$183 annual deductible
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network
$6,700 In-network
Optional Supplemental BenefitsYes

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$450 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Out-of-Network:20% per stay
Outpatient hospital coverageIn-Network:20% per visit
Out-of-Network:20% per visit
Doctor visitsPrimary:
In-Network:20% per visit
Out-of-Network:20% per visit
Specialist:
In-Network:20% per visit
Out-of-Network:20% per visit
Preventive careIn-Network:$0 copay
Out-of-Network:$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:20% per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:$0 or 20%
Out-of-Network:$0 or 20%
Lab services:
In-Network:$0 or 20%
Out-of-Network:20%
Diagnostic radiology services (e.g., MRI):
In-Network:20%
Out-of-Network:20%
Outpatient x-rays:
In-Network:20%
Out-of-Network:20%
Mental health servicesInpatient hospital - psychiatric:
In-Network:$397 per day for days 1 through 4
$0 per day for days 5 through 90
Out-of-Network:20% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:20%
Out-of-Network:20%
Outpatient individual therapy visit with a psychiatrist:
In-Network:20%
Out-of-Network:20%
Outpatient group therapy visit:
In-Network:20%
Out-of-Network:20%
Outpatient individual therapy visit:
In-Network:20%
Out-of-Network:20%
Skilled Nursing FacilityIn-Network:$0 per day for days 1 through 20
$172 per day for days 21 through 100
Out-of-Network:$0 per day for days 1 through 20
$172 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:
In-Network:20%
Out-of-Network:20%
Physical therapy and speech and language therapy visit:
In-Network:20%
Out-of-Network:20%
Ground ambulanceIn-Network:20%
Out-of-Network:20%
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:20%
Out-of-Network:20%
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:15% per item
Out-of-Network:20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:20% per item
Out-of-Network:20% per item
Diabetes supplies:
In-Network:$0 or 10-20% per item
Out-of-Network:20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:20%
Out-of-Network:20%
Other Part B drugs:
In-Network:20%
Out-of-Network:20%

Benefits Services

Hearing
Hearing examIn-Network: 20%
Out-of-Network: 20%
Fitting/evaluationIn-Network: $0
Out-of-Network: 50%
There may be limits on how much the plan will provide.
Hearing aidsIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Preventive Dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-ray(s)Not covered
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye examNot covered
OtherNot covered
Contact lensesNot covered
Eyeglasses (frames and lenses)Not covered
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for HumanaChoice R5361-002 (Regional PPO)

StateIllinois
CountyCook

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$3 copay$10 copay$3 copay
Tier 2: Non-Preferred Generic$9 copay$20 copay$9 copay
Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Brand Name$100 copay$100 copay$100 copay
Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance
Tier 6: Select Care Drugs

90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$9 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$27 copay$60 copay$0 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$131 copay
Tier 4: Non-Preferred Brand Name$300 copay$300 copay$290 copay
Tier 5: Specialty Tier
Tier 6: Select Care Drugs

Physicians that accept HumanaChoice R5361-002 (Regional PPO) for Illinois

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Andree, De Bustros
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Theodore, Christou
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Kenyatta, Frazier
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Joseph, Lopez
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Erin, Jamen
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Jennifer, Perez
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Parakrama, De Silva
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Smain, Sadok
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Charles, Allen
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Anthony, Bozzano
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Luis, Angarita
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Andree De Bustros, M.D.
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  • Phone Number
    (312) 567-7500
  • Office Locations
    5525 S Pulaski Rd
    Chicago, IL 60629
5525 S Pulaski Rd Chicago IL, 60629

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Medicare Plans Found

 

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.