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HumanaChoice R4182-004 (Regional PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice R4182-004 (Regional PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice R4182-004 (Regional PPO) in 2026, please refer to our full plan details page.
HumanaChoice R4182-004 (Regional PPO) is a Regional PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in State of Texas. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice R4182-004 (Regional PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice R4182-004 (Regional PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HumanaChoice R4182-004 (Regional PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HumanaChoice R4182-004 (Regional PPO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, with a $5 copay for a 1-month supply at standard pharmacies or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail-order options. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 43% coinsurance, while Tier 5 specialty drugs have a 25% coinsurance for a 1-month supply. Choosing the right pharmacy and mail-order options under this plan can significantly lower your out-of-pocket prescription expenses.
Additional Benefits
The HumanaChoice R4182-004 (Regional PPO) plan offers comprehensive coverage with no copay or coinsurance for primary care doctor visits, home health services, and routine preventive care. For hospital care, inpatient stays require a daily copay for the first six days with no coinsurance, while emergency room visits carry a $115 copay that is waived upon admission. Outpatient services feature no coinsurance, with no copay for ambulatory surgical center visits and variable copays for other outpatient hospital care. Specialist visits require a $50 copay, but routine annual vision, hearing, and preventive dental exams are available with no copay. Essential recovery services like skilled nursing facility stays offer no copay for the first 20 days, whereas durable medical equipment and dialysis services require a 20% coinsurance. Overall, this plan provides a balance of no-copay routine services and predictable copays or coinsurance for advanced medical care.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HumanaChoice R4182-004 (Regional PPO) with no coinsurance, requiring a $380 daily copay for days 1 to 6 of acute stays and a $339 daily copay for days 1 to 6 of psychiatric stays. There is no copay for subsequent covered days, but prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice R4182-004 (Regional PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $350, observation services require a $380 copay per stay, and outpatient substance abuse sessions have a copay of $30 to $35.
Partial Hospitalization See details
HumanaChoice R4182-004 (Regional PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice R4182-004 (Regional PPO) covers ambulance services with a $335 copay for ground transport and a 20% coinsurance for air transport, with prior authorization required for both. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HumanaChoice R4182-004 (Regional PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice R4182-004 (Regional PPO) primary care benefits feature no copay and no coinsurance for primary care physician visits, while specialist visits require a $50 copay and no coinsurance. Physical, occupational, and speech therapies have a $25 copay with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice R4182-004 (Regional PPO) covers Medicare-covered preventive services, annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. Additional preventive services, such as fitness benefits, health education, and nutritional counseling, are not covered.
Hearing Services See details
HumanaChoice R4182-004 (Regional PPO) covers hearing exams with no coinsurance, requiring a $50 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice R4182-004 (Regional PPO) partially covers vision services with no deductibles, no coinsurance, and copays ranging from $0 to $50. Routine eye exams and select eyewear, such as contact lenses or complete eyeglasses, are covered with no copay up to annual maximum limits, while other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice R4182-004 (Regional PPO), requiring a $50 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and select comprehensive services. However, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice R4182-004 (Regional PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice R4182-004 (Regional PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HumanaChoice R4182-004 (Regional PPO), featuring a 20% coinsurance and no copay for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice R4182-004 (Regional PPO) subject to prior authorization. Diagnostic services feature no coinsurance, offering no copay for lab tests and copays from $0 to $175 for procedures, while radiological services range from no copay for X-rays to a minimum 20% coinsurance and $45 copay for therapeutic treatments.
Home Health Services See details
Home Health Services are covered under the HumanaChoice R4182-004 (Regional PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice R4182-004 (Regional PPO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copays ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
HumanaChoice R4182-004 (Regional PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no required 3-day prior hospital stay, though prior authorization is necessary. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice R4182-004 (Regional PPO) partially covers other services, offering acupuncture for a $50 copay and no coinsurance up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for these covered services, while over-the-counter (OTC) items are not covered.
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