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HumanaChoice R5826-074 (Regional PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice R5826-074 (Regional PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice R5826-074 (Regional PPO) in 2025, please refer to our full plan details page.
HumanaChoice R5826-074 (Regional PPO) is a Regional PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Florida RPPO. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that HumanaChoice R5826-074 (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 R5826-074 (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 R5826-074 (Regional PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.00. 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.
This plan has a $395.00 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 $10500.00 (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 $10500.00 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 R5826-074 (Regional PPO) plan has a $395 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, for a standard generic drug, you will pay a $20 copay at a standard pharmacy, and a $47 copay at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice R5826-074 (Regional PPO) plan offers coverage for a wide range of services, including inpatient hospital stays with a copay, outpatient services, and emergency care. You'll have a $35 copay for primary care visits, and specialist visits have a $50 copay. The plan also covers preventive services with no copay, as well as hearing and vision services with some copays and no copays for certain services. This plan provides coverage for dental services, home infusion, dialysis, and medical equipment with varying cost-sharing amounts, including copays and coinsurance. Additionally, you'll find coverage for home health services with no copay, and skilled nursing facility (SNF) services. Other benefits include ambulance services, and other services like acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered, with a copay of $625 for days 1-3 and no copay for days 4-90 for acute care, and a copay of $587 for days 1-3 and no copay for days 4-90 for psychiatric care. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute and additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $390, observation services with a $625 copay, and ambulatory surgical center services with no copay. Outpatient Substance Abuse services include a copay between $30 and $100 for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice R5826-074 (Regional PPO). 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 by the HumanaChoice R5826-074 (Regional PPO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $25 copay, and Worldwide Emergency Services has a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HumanaChoice R5826-074 (Regional PPO) plan covers primary care physician services with a $35 copay, chiropractic services with a $15 copay, and occupational therapy services with a $10-$35 copay. The plan also covers physician specialist services with a $50 copay, mental health specialty services, psychiatric services, and opioid treatment program services with a $30-$100 copay. Physical therapy and speech-language pathology services have a $10-$35 copay, and additional telehealth benefits have a $0-$50 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HumanaChoice R5826-074 (Regional PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. Some preventive services, such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The HumanaChoice R5826-074 (Regional PPO) plan covers hearing exams with a $50 copay, routine hearing exams with no copay for one visit every year, and fitting/evaluation for hearing aids with no copay for one visit every year. Prescription hearing aids are covered up to $1,000 every three years, and OTC hearing aids are covered with no copay, up to $1,000 every three years.
Vision Services See details
Vision Services includes coverage for eye exams with a copay between $0 and $50, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice R5826-074 (Regional PPO) plan covers Medicare dental services with a $50 copay, 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, maxillofacial prosthetics, implant services, prosthodontics, fixed, 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, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice R5826-074 (Regional PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and no copay, while Prosthetics/Medical Supplies and Diabetic Supplies have a 20% coinsurance and no copay for some services. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the HumanaChoice R5826-074 (Regional PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $290, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $350, Therapeutic Radiological Services have a copay of at most $50 and a coinsurance of at least 20%, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice R5826-074 (Regional PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice R5826-074 (Regional PPO) but are not covered in practice. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice R5826-074 (Regional PPO) plan, with prior authorization required. There is no copay for days 1-20, and a $167 copay for days 21-100, and additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year; however, Over-the-Counter (OTC) Items, Meal Benefit, 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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