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HumanaChoice R5826-018 (Regional PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice R5826-018 (Regional PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice R5826-018 (Regional PPO) in 2025, please refer to our full plan details page.
HumanaChoice R5826-018 (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 R5826-018 (Regional PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice R5826-018 (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 R5826-018 (Regional PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $1300.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by HumanaChoice R5826-018 (Regional PPO).
Additional Benefits
The HumanaChoice R5826-018 (Regional PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including some mental health and substance abuse services, have copays. Emergency and primary care services, including an annual physical, have copays, and some preventive services are covered with no copay. Additional benefits include coverage for hearing exams, prescription hearing aids, and some dental services with copays or coinsurance. The plan also covers home infusion, dialysis, and medical equipment with copays or coinsurance. Home health services have no copay, and skilled nursing facility services have a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, but non-Medicare covered stays and upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you will pay a $195 copay for days 1-9, and no copay for days 10-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $100, observation services with a $275 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services include individual sessions with a copay between $0 and $30, and group sessions with a copay between $0 and $30. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice R5826-018 (Regional PPO) plan. Ground Ambulance Services have a copay between $120 and $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. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services have a $25 copay.
Primary Care See details
The HumanaChoice R5826-018 (Regional PPO) plan covers Primary Care Physician Services with a $5 copay, Chiropractic Services with a $15 copay (prior authorization required, routine care not covered), Occupational Therapy Services with a $25-$35 copay (prior authorization required), Physician Specialist Services with a $30 copay, Mental Health Specialty Services and Psychiatric Services individual and group sessions with a $30 copay (prior authorization required), Physical Therapy and Speech-Language Pathology Services with a $25-$35 copay (prior authorization required), Additional Telehealth Benefits with a $0-$30 copay, and Opioid Treatment Program Services with a $0-$30 copay (prior authorization required). Podiatry Services are not covered.
Preventive Services See details
The HumanaChoice R5826-018 (Regional PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, are covered, with no copay for some services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit.
Hearing Services See details
Hearing exams are covered with a $30 copay and prescription hearing aids are covered up to $1000 every three years. Routine hearing exams and fitting/evaluations for hearing aids are covered with no copay. OTC hearing aids are covered with no copay and up to $1000 every three years, while prescription hearing aids - 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-$30, and eyewear, with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Periodontics, Prosthodontics (removable) with a 30% coinsurance, and Oral and Maxillofacial Surgery with no copay. Fluoride Treatment, Endodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered. The plan has a $1,000 maximum benefit per year for both in and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice R5826-018 (Regional PPO) plan, but require prior authorization. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 10% coinsurance with no copay, Prosthetic Devices have a 20% coinsurance, and Medical Supplies have an 18% coinsurance. Diabetic Supplies have a 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The HumanaChoice R5826-018 (Regional PPO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $100, and lab services with no copay. Radiological services include diagnostic radiological services with a copay up to $125, therapeutic radiological services with a copay up to $30 and 20% coinsurance, and outpatient X-ray services with a $5 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice R5826-018 (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
HumanaChoice R5826-018 (Regional PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice R5826-018 (Regional PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $150 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
Other Services includes acupuncture, which has no copay and is limited to 25 treatments per year with prior authorization required; however, 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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