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HumanaChoice R5361-002 (Regional PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice R5361-002 (Regional PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice R5361-002 (Regional PPO) in 2025, please refer to our full plan details page.
HumanaChoice R5361-002 (Regional PPO) is a Regional PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in States of Illinois and Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice R5361-002 (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 R5361-002 (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 R5361-002 (Regional PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $104.00. 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 $590.00 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 $14000.00 (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 $14000.00 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 R5361-002 (Regional PPO) plan has an enhanced alternative drug benefit. Before your coverage begins, you must pay a deductible of $590. After the deductible, you will pay coinsurance for your prescriptions. During the initial coverage phase, you will pay 25% coinsurance for preferred and standard generic drugs, 27% coinsurance for preferred brand drugs, and 25% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice R5361-002 (Regional PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services, including doctor visits and some therapies, typically have a 20% coinsurance. The plan also covers preventive services, such as an annual physical exam, with no copay, and offers additional benefits such as dental, vision, and hearing services, with specific copays and coinsurance amounts depending on the service. This plan covers emergency services with a copay, and offers coverage for ambulance services with a 20% coinsurance. Home health services and skilled nursing facilities are covered, with different cost-sharing structures. Additionally, the plan includes coverage for medical equipment, diagnostic services, and other services like acupuncture, and dialysis.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered. For acute inpatient hospital stays, you'll pay a $570 copay for days 1-4 and no copay for days 5-90, and for inpatient psychiatric stays, you'll pay a $505 copay for days 1-4 and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 20% coinsurance and no copay, Observation Services with a $570 copay, Ambulatory Surgical Center (ASC) Services with no copay and a coinsurance between 20-20%, Outpatient Substance Abuse Services with a coinsurance between 20-20% for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the HumanaChoice R5361-002 (Regional PPO) plan. Ground and Air Ambulance Services have a 20% coinsurance, while 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 R5361-002 (Regional PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay, with no coinsurance.
Primary Care See details
The HumanaChoice R5361-002 (Regional PPO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, and Additional Telehealth Benefits have a copay between $0 and $45. Chiropractic Services, Occupational Therapy Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
The HumanaChoice R5361-002 (Regional PPO) plan covers preventive services, including an annual physical exam with no copay, while additional preventive services may have a copay. Kidney disease education services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and other services are not covered.
Hearing Services See details
Hearing Services include hearing exams, and prescription hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and a copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $699 and $999 for all types of prescription hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The HumanaChoice R5361-002 (Regional PPO) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear with no copay. The plan does not cover eyeglass lenses, eyeglass frames, or upgrades.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Adjunctive general services are covered with no copay.
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 a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the HumanaChoice R5361-002 (Regional PPO) plan. Durable Medical Equipment has a 15% coinsurance, while medical supplies and prosthetic devices have a 20% coinsurance; diabetic supplies have between a 10% and 20% coinsurance, and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic procedures/tests have a coinsurance of at most 20% and a copay of at most $45, while lab services have a coinsurance of at most 20% and no copay. Diagnostic radiological services have a coinsurance of at most 20% and a copay of at most $570, therapeutic radiological services have a coinsurance of at most 20%, and outpatient X-ray services have a coinsurance of at most 20% and a $45 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice R5361-002 (Regional PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice R5361-002 (Regional PPO) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice R5361-002 (Regional PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203.
Other Services See details
The HumanaChoice R5361-002 (Regional PPO) plan covers acupuncture with a 20% coinsurance, and a limit of 20 treatments per year. The plan also offers a meal benefit with no copay. Other services, including over-the-counter items, are not covered.
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