HumanaChoice R0110-017 (Regional PPO)

Inpatient Hospital See details

Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you'll pay a $280 copay for days 1-5, and no copay for days 6-90; additional days have no copay. Psychiatric care has the same cost-sharing as acute care, but additional days and non-Medicare stays for psychiatric care are not covered.

Outpatient Services See details

Outpatient Services, including all outpatient hospital services, are covered by HumanaChoice R0110-017, with copays ranging from $0 to $95. Observation Services have a $280 copay per stay, while Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services are covered with a $30 copay for both individual and group sessions, and Outpatient Blood Services are covered with no copay.

Partial Hospitalization See details

Partial Hospitalization is covered under the HumanaChoice R0110-017 (Regional PPO) plan, with a $30 copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, while air ambulance services have 20% coinsurance, and transportation services to any health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; all services have no coinsurance.

Primary Care See details

The HumanaChoice R0110-017 (Regional PPO) plan covers primary care physician services with a $10 copay. Chiropractic services and occupational therapy services are covered with copays of $20, while routine chiropractic care is not covered.

Specialist visits have a $30 copay, and mental health and psychiatric individual and group sessions have a $30 copay.

Physical therapy and speech-language pathology services have a $20 copay, and additional telehealth benefits have a copay between $0 and $55.

Opioid treatment program services have a copay of $30.

Preventive Services See details

The HumanaChoice R0110-017 (Regional PPO) plan covers preventive services, including Medicare-covered preventive services, an annual physical exam with no copay, and fitness benefits with no copay. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. However, services such as Health Education, In-Home Safety Assessment, and others are not covered.

Hearing Services See details

Hearing services include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $699. Prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.

Vision Services See details

The HumanaChoice R0110-017 (Regional PPO) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.

Dental Services See details

Dental services are covered, including Medicare dental services with a $30 copay, oral exams, dental X-Rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Restorative services and prosthodontics (fixed) have a 30% - 40% coinsurance and no copay, while endodontics, periodontics, and oral and maxillofacial surgery have no copay. Fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance applies between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered, with a coinsurance of 20%. Prior authorization is required.

Medical Equipment See details

Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, are covered. Durable Medical Equipment has a 15% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $55, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $150, Therapeutic Radiological Services have a copay between $30 and $50, and Outpatient X-Ray Services have a $10 copay.

Home Health Services See details

Home Health Services are covered by the HumanaChoice R0110-017 (Regional PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are generally covered, but specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required and the copay varies.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, the copay is $10 per day, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.

Other Services See details

Other Services includes coverage for acupuncture with a $30 copay, limited to 20 treatments per year with prior authorization, and a meal benefit with no copay and prior authorization. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.