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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
HumanaChoice R5361-002 (Regional PPO) is a Regional PPO plan offered by Humana Insurance Company available for the 2026 plan year to people living in States of Illinois and Wisconsin. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $103.00. 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 has a $100.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7200.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7200.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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) Medicare plan features an annual 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, starting with a $5 copay for a 1-month supply at standard pharmacies and no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with a 3-month supply costing $131 through preferred mail order or $141 at standard pharmacies. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 42% coinsurance across standard pharmacies and mail order options. Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply through standard pharmacies, preferred mail order, and standard mail order.
Additional Benefits
The HumanaChoice R5361-002 (Regional PPO) plan provides affordable access to essential medical care, featuring no copay and no coinsurance for primary care doctor visits and preventive services. For more specialized treatment, outpatient hospital services carry a $0 to $35 copay and 20% coinsurance, while specialist visits require no copay and 20% coinsurance. If inpatient hospital care is needed, members pay a daily copay of $600 for the first four days of acute care, with no copay required for the remaining days of the stay. In addition to medical care, this plan covers valuable supplemental benefits including dental, vision, and hearing services, offering no copay for routine preventive dental care, routine eye exams, and hearing aid fittings. Routine eyewear is covered with no copay or coinsurance up to a $100 annual limit, and prescription hearing aids carry copays ranging from $699 to $999. Skilled nursing facility stays are also highly accessible, requiring no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Inpatient hospital services are covered by HumanaChoice R5361-002 (Regional PPO) with no coinsurance, though prior authorization is required. Acute care requires a $600 daily copay for days 1 to 4 and no copay for days 5 and beyond, while psychiatric care requires a $520 daily copay for days 1 to 4 and no copay for days 5 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by HumanaChoice R5361-002 (Regional PPO) include outpatient hospital care with a $0 to $35 copay and 20% coinsurance, and ambulatory surgical center services with no copay and 20% coinsurance. Outpatient substance abuse treatments require a $35 copay and 20% coinsurance, while observation services incur a $600 copay per stay along with coinsurance. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by HumanaChoice R5361-002 (Regional PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice R5361-002 (Regional PPO), which features a $335 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Prior authorization is required for ambulance transport, these costs are not waived if admitted to the hospital, and additional transportation services to health-related locations are not covered.
Emergency Services See details
HumanaChoice R5361-002 (Regional PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services have a $40 copay, and worldwide emergency, urgent, and transportation services are covered with a $115 copay, all with no coinsurance.
Primary Care See details
HumanaChoice R5361-002 (Regional PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy, and mental health services require no copay and 20% coinsurance. Podiatry and chiropractic services are not covered, but telehealth is offered with a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
HumanaChoice R5361-002 (Regional PPO) covers preventive services with no copay and no coinsurance, including annual physicals, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, EKGs, and memory fitness. These benefits are partially covered, as the plan excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
HumanaChoice R5361-002 (Regional PPO) partially covers hearing services with no deductible, offering annual routine hearing exams for a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to two per year with copays ranging from $699 to $999 and no coinsurance, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice R5361-002 (Regional PPO) with no deductibles. Routine eye exams have no copay and a 20% coinsurance up to a $75 annual limit, and eyewear has no copay and no coinsurance up to a $100 annual limit; however, other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice R5361-002 (Regional PPO), featuring no copay and 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice R5361-002 (Regional PPO) with no copay, though prior authorization and step therapy are required. Medicare Part B chemotherapy, radiation, and other drugs have coinsurance ranging from no coinsurance up to 20%, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice R5361-002 (Regional PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice R5361-002 (Regional PPO) covers durable medical equipment (DME), prosthetics, and medical supplies with 20% coinsurance and no copay. Covered diabetic supplies carry 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 R5361-002 (Regional PPO) with a 20% coinsurance and require prior authorization. There is no copay for lab services, outpatient X-rays, and diagnostic radiological services, while diagnostic procedures and tests have a copay ranging from $0 to $40.
Home Health Services See details
Home Health Services are covered by HumanaChoice R5361-002 (Regional PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice R5361-002 (Regional PPO) with no copay and no coinsurance, but prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
HumanaChoice R5361-002 (Regional PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice R5361-002 (Regional PPO) partially covers other services, offering acupuncture with no copay and a 20% coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this benefit.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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