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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 2026, 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 3.5 out of 5 stars in 2026.
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 $184.00. 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 $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 $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) 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 medications cost a $15 copay for a 1-month supply at standard pharmacies, though you can get a 3-month supply with no copay through 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 50% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
HumanaChoice R5826-005 (Regional PPO) offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialist visits, patients will pay a $45 copay, while inpatient hospital stays require a daily copay of $250 for the first seven days and no copay for days eight through 90. Outpatient services feature no coinsurance and copays ranging from no copay up to $195. This plan also includes supplemental dental, vision, and hearing benefits, featuring no copay for routine exams and preventive care. Dental services are covered up to a $1,000 annual limit with a $25 copay for restorative care, while prescription hearing aids are covered up to a $1,000 limit every three years. Additionally, emergency care is available with a $130 copay, and durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice R5826-005 (Regional PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a daily copay of $250 for days 1 through 7 and no copay for days 8 through 90. Prior authorization is required, and while unlimited additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice R5826-005 (Regional PPO) covers outpatient services with no coinsurance, featuring a $0 to $195 copay for outpatient hospital services ($250 per stay for observation) and a $30 to $35 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, though prior authorization is required for outpatient care.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice R5826-005 (Regional PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice R5826-005 (Regional PPO) covers ambulance services with a $120.00 to $240.00 copay for ground transport and a 20% coinsurance for air transport, both requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by HumanaChoice R5826-005 (Regional PPO) with a $130 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available for a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice R5826-005 (Regional PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Other services like physical and occupational therapy require a $15 to $40 copay, while mental health sessions carry a $30 copay, all with no coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services under HumanaChoice R5826-005 (Regional PPO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and memory fitness. However, this benefit is only partially covered, as several supplemental services such as health education, weight management programs, and in-home support are not covered.
Hearing Services See details
HumanaChoice R5826-005 (Regional PPO) offers hearing services with no copay and no coinsurance for annual routine exams, fitting evaluations, and OTC hearing aids, though Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 limit every three years, but inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
HumanaChoice R5826-005 (Regional PPO) offers partially covered vision services with no copay and no coinsurance for annual routine eye exams and eyewear, though prior authorization is required. While routine exams (up to $75) and eyeglasses or contact lenses (up to $100) are covered, other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice R5826-005 (Regional PPO) offers partially covered dental services with a $1,000 annual maximum, featuring no copay and no coinsurance for preventive care, a $25 copay and no coinsurance for restorative services, and a $45 copay and no coinsurance for Medicare-covered dental. Fluoride, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice R5826-005 (Regional PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Medicare Part B drugs, such as chemotherapy, radiation, and other drugs, have coinsurance ranging from no coinsurance to 20%, while insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
HumanaChoice R5826-005 (Regional PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment is covered by HumanaChoice R5826-005 (Regional PPO) with a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic supplies. Diabetic therapeutic shoes and inserts are covered with a $5 copay, and prior authorization is required for most items.
Diagnostic and Radiological Services See details
HumanaChoice R5826-005 (Regional PPO) covers diagnostic and radiological services, offering lab services and outpatient X-rays with no copay, and diagnostic tests ranging from no copay up to $150 with no coinsurance. Diagnostic radiological services start at no copay, while therapeutic radiological services require a minimum $45 copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by HumanaChoice R5826-005 (Regional PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice R5826-005 (Regional PPO) with no coinsurance and required prior authorization, though only some services are covered. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered under this plan.
Skilled Nursing Facility (SNF) See details
HumanaChoice R5826-005 (Regional PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $160 daily copay for days 21 through 100, with no coverage provided for additional days beyond the standard 100-day Medicare limit.
Other Services See details
HumanaChoice R5826-005 (Regional PPO) partially covers other services, offering acupuncture with no copay and no coinsurance for up to 25 treatments per year, though prior authorization is required. Over-the-counter (OTC) items and meal benefits are not covered.
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