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HumanaChoice R5826-005 (Regional PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice R5826-005 (Regional PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice R5826-005 (Regional PPO) in 2025, please refer to our full plan details page.
HumanaChoice R5826-005 (Regional PPO) is a Regional PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in State of Florida. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that HumanaChoice R5826-005 (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 R5826-005 (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 R5826-005 (Regional PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $172.00. 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 $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $100.00 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 $10000.00 (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 $10000.00 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 R5826-005 (Regional PPO) plan has a $100 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $15 copay for preferred generic drugs at a standard pharmacy. For preferred brand drugs, you'll pay 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice R5826-005 (Regional PPO) plan offers a range of benefits including inpatient hospital stays, outpatient services, and emergency services. Many services have a copay, such as primary care visits for $5 and specialist visits for $45. The plan also includes coverage for vision, hearing, and dental services, as well as medical equipment and home health services. This plan also covers preventive services, with no copay for an annual physical exam, and offers no copay for many services, including routine hearing exams, fitting/evaluation for hearing aids, and certain vision services. Other benefits include coverage for ambulance services, skilled nursing facility stays, and cardiac rehabilitation services. However, some services such as podiatry, certain dental and vision services, and some transportation and home care services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 7 days of an inpatient stay, the copay is $250 per day, and days 8-90 have no copay; additional days 91-999 have no copay.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $195, Observation Services have a $250 copay, Ambulatory Surgical Center Services have no copay, and Outpatient Blood Services have no copay. For Individual and Group Sessions for Outpatient Substance Abuse, the copay is between $30 and $100.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice R5826-005 (Regional PPO) plan. This benefit has a $45 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice R5826-005 (Regional PPO) plan. Ground Ambulance Services have a copay of $120-$240, while Air Ambulance Services have a 20% coinsurance. 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 R5826-005 (Regional PPO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay, while Urgently Needed Services has a $25 copay, with no coinsurance for any of these services.
Primary Care See details
The HumanaChoice R5826-005 (Regional PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, occupational therapy services with a copay between $15 and $40, and physician specialist services with a $45 copay. The plan also covers mental health services and psychiatric services with a $30 copay for individual and group sessions. Physical therapy and speech-language pathology services have a copay between $15 and $40. Additional telehealth benefits range from no copay to a $45 copay, and opioid treatment program services have a copay between $30 and $100. Podiatry services are not covered.
Preventive Services See details
The HumanaChoice R5826-005 (Regional PPO) plan covers preventive services including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are also covered, and may have a copay depending on the specific service.
Hearing Services See details
HumanaChoice R5826-005 (Regional PPO) covers hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $1000 every three years, and OTC hearing aids are covered with no copay, also with a maximum benefit of $1000 every three years. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$45, and eyewear including contact lenses and eyeglasses (lenses and frames) with no copay, though eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan has a maximum benefit of $75 for eye exams and $100 for eyewear per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $45 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services with a $25 copay, and Adjunctive General Services with no copay. Fluoride Treatment, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. 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 under the HumanaChoice R5826-005 (Regional PPO) plan, but require prior authorization. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance with no copay, while Prosthetic Devices and Medicare-covered Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay of $0 to $150, Lab Services have no copay, Diagnostic Radiological Services have a copay of $0 to $150, Therapeutic Radiological Services have a copay of up to $45 and a coinsurance of up to 20%, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice R5826-005 (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 covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice R5826-005 (Regional PPO) plan, requiring prior authorization. There is no copay for days 1-20, and a $150 copay for days 21-100.
Other Services See details
Other services include acupuncture with no copay, though a maximum of 25 treatments are covered per year and prior authorization is required. Over-the-counter items, meal benefits, 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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