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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 2025, 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 2025.
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 $83.00. 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 $350.00 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 $10300.00 (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 $10300.00 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) plan has a $350 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $13 copay at preferred and mail-order pharmacies and a $20 copay at standard pharmacies. For standard generic drugs, the copay is $47, and for preferred brand drugs, you pay 48% coinsurance. You will pay 28% coinsurance for non-preferred drugs.
Additional Benefits
The HumanaChoice R4182-004 (Regional PPO) plan offers coverage for a range of services with varying costs. For inpatient hospital stays, you'll pay a copay for the first few days, with no copay after that, while outpatient services have copays ranging from $0-$350. Emergency services and primary care visits come with copays, and preventive services like annual physical exams have no copay. The plan also includes coverage for hearing and vision services, with copays for exams, and a copay for hearing aids. Dental services cover Medicare dental services and preventative services with a $50 copay. Additional benefits include home infusion, dialysis, medical equipment, and diagnostic services, each with specific copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital-Acute, you will pay a $380 copay for days 1-6, and no copay for days 7-90, and for Inpatient Hospital Psychiatric, you will pay a $339 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999.
Outpatient Services See details
Outpatient hospital services have a copay between $45 and $350, and observation services have a $380 copay. Ambulatory surgical center services have a $275 copay, while outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay between $30 and $100.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice R4182-004 (Regional PPO) plan, but requires prior authorization. You will pay a $45 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice R4182-004 (Regional PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a copay of $315, while air ambulance services have a 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 under the HumanaChoice R4182-004 (Regional PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The HumanaChoice R4182-004 (Regional PPO) plan covers primary care physician services with a $20 copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. Additionally, specialist visits have a $50 copay, individual and group mental health and psychiatric sessions have a $30 copay, physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a copay between $0 and $50. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HumanaChoice R4182-004 (Regional PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like health education, in-home safety assessments, and others are not covered, but the plan covers glaucoma screenings, diabetes self-management training, and other services with no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $50 copay and routine hearing exams with no copay for one visit every year, as well as fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999 for two visits every year, but prescription hearing aids for the inner, outer, or over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$50 and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice R4182-004 (Regional PPO) covers Medicare Dental Services with a $50 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. However, fluoride treatment, restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice R4182-004 (Regional PPO), including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice R4182-004 (Regional PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by HumanaChoice R4182-004 (Regional PPO), including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 10-20% coinsurance and a $0-$10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered with a copay of up to $175, and no coinsurance. Outpatient X-ray services have a $20 copay, while diagnostic radiological services have a copay of up to $325, and therapeutic radiological services have a copay of at most $45 and a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by HumanaChoice R4182-004 (Regional PPO) 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 covered, but specific services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. 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 $50 copay and up to 20 treatments per year, and a meal benefit with no copay. 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.
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