HumanaChoice R0110-003 (Regional PPO) is a Medicare Advantage Plan by Humana.
This page features plan details for 2024 HumanaChoice R0110-003 (Regional PPO) R0110 – 003 – 0 available in States of Louisiana and Mississippi.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
HumanaChoice R0110-003 (Regional PPO) is offered in the following locations.
HumanaChoice R0110-003 (Regional PPO) offers the following coverage and cost-sharing.
Insurer: | Humana |
Health Plan Deductible: | $0.00 |
MOOP: | $3,500.00 |
Drugs Covered: | Yes |
Ready to sign up for HumanaChoice R0110-003 (Regional PPO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $91.00 | $59.00 | $0.00 | $324.70 |
HumanaChoice R0110-003 (Regional PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced Alternative |
Additional Gap Coverage: | |
Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$59.00 | $ |
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | $15.00 copay | |
2 (Generic) | $5.00 copay | $5.00 copay | $20.00 copay | |
3 (Preferred Brand) | $47.00 copay | $47.00 copay | $47.00 copay | |
4 (Non-Preferred Drug) | $99.00 copay | $99.00 copay | $100.00 copay | |
5 (Specialty Tier) | 33% | 33% | 33% |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | $45.00 copay | |
2 (Generic) | $15.00 copay | $0.00 copay | $60.00 copay | |
3 (Preferred Brand) | $141.00 copay | $131.00 copay | $141.00 copay | |
4 (Non-Preferred Drug) | $297.00 copay | $287.00 copay | $300.00 copay | |
5 (Specialty Tier) |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.
HumanaChoice R0110-003 (Regional PPO) also provides the following benefits.
$0 |
In-network | No |
$5,750 In and Out-of-network $3,500 In-network |
No |
In-network | Yes, contact plan for further details |
In-network | $0-175 copay per visit (Authorization is required.) (Referral is not required.) |
out-of-network | $0-175 copay per visit (Authorization is required.) (Referral is not required.) |
In-network Primary | $5 copay per visit (Not applicable.) (Not applicable.) |
out-of-network Primary | $5 copay per visit (Not applicable.) (Not applicable.) |
In-network Specialist | $35 copay per visit (Authorization is not required.) (Referral is not required.) |
out-of-network Specialist | $35 copay per visit (Authorization is not required.) (Referral is not required.) |
In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
out-of-network | $0 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $135 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $65 copay per visit (always covered) (Not applicable.) (Not applicable.) |
In-network Diagnostic tests and procedures | $0-100 copay (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic tests and procedures | $0-100 copay (Authorization is required.) (Referral is not required.) |
In-network Lab services | $0-40 copay (Authorization is required.) (Referral is not required.) |
out-of-network Lab services | $0-40 copay (Authorization is required.) (Referral is not required.) |
In-network Diagnostic radiology services (e.g., MRI) | $0-300 copay (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic radiology services (e.g., MRI) | $0-300 copay (Authorization is required.) (Referral is not required.) |
In-network Outpatient x-rays | $5-125 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient x-rays | $5-125 copay (Authorization is required.) (Referral is not required.) |
In-network Hearing exam | $35 copay (Authorization is required.) (Referral is not required.) |
out-of-network Hearing exam | $35 copay (Authorization is required.) (Referral is not required.) |
In-network Fitting/evaluation | $0 copay (There are no limits.) (Authorization is required.) (Referral is not required.) |
out-of-network Fitting/evaluation | 50% coinsurance (There are no limits.) (Authorization is required.) (Referral is not required.) |
In-network Hearing aids | $699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Hearing aids | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Non-routine services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Non-routine services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Restorative services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Restorative services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Endodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Endodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Periodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Periodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Extractions | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Extractions | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Contact lenses | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
In-network Occupational therapy visit | $25 copay (Authorization is required.) (Referral is not required.) |
out-of-network Occupational therapy visit | $25 copay (Authorization is required.) (Referral is not required.) |
In-network Physical therapy and speech and language therapy visit | $25 copay (Authorization is required.) (Referral is not required.) |
out-of-network Physical therapy and speech and language therapy visit | $25 copay (Authorization is required.) (Referral is not required.) |
In-network | $300 copay (Not applicable.) (Not applicable.) |
out-of-network | $300 copay (Not applicable.) (Not applicable.) |
Not covered (Not applicable.) (Not applicable.) |
In-network Foot exams and treatment | $35 copay (Authorization is required.) (Referral is not required.) |
out-of-network Foot exams and treatment | $35 copay (Authorization is required.) (Referral is not required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 17% coinsurance per item (Authorization is required.) (Not applicable.) |
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 17% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
out-of-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Diabetes supplies | $0 copay or 10-20% coinsurance per item (Authorization is required.) (Not applicable.) |
out-of-network Diabetes supplies | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Covered (Authorization is required.) (Referral is not required.) |
In-network Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
out-of-network Chemotherapy | 20% coinsurance (Authorization is required.) (Not applicable.) |
In-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
out-of-network Other Part B drugs | 20% coinsurance (Authorization is required.) (Not applicable.) |
In-network Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
out-of-network Part B Insulin drugs | 20% coinsurance (Authorization is required.) (Not applicable.) |
In-network | $0 copay per stay (Authorization is required.) (Referral is not required.) |
out-of-network | $0 copay per stay (Authorization is required.) (Referral is not required.) |
In-network Inpatient hospital – psychiatric | $250 per stay (Authorization is required.) (Referral is not required.) |
out-of-network Inpatient hospital – psychiatric | $250 per stay (Authorization is required.) (Referral is not required.) |
In-network Outpatient group therapy visit with a psychiatrist | $30 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient group therapy visit with a psychiatrist | $30 copay (Authorization is required.) (Referral is not required.) |
In-network Outpatient individual therapy visit with a psychiatrist | $30 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient individual therapy visit with a psychiatrist | $30 copay (Authorization is required.) (Referral is not required.) |
In-network Outpatient group therapy visit | $30 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient group therapy visit | $30 copay (Authorization is required.) (Referral is not required.) |
In-network Outpatient individual therapy visit | $30 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient individual therapy visit | $30 copay (Authorization is required.) (Referral is not required.) |
In-network | $20 per day for days 1 through 20 $203 per day for days 21 through 100 (Authorization is required.) (Referral is not required.) |
out-of-network | $0 per day for days 1 through 20 $203 per day for days 21 through 100 (Authorization is required.) (Referral is not required.) |
Preventive dental: | Monthly Premium: | $33.70 |
Preventive dental: | Deductible: | N/A |
Comprehensive dental: | Monthly Premium: | $33.70 |
Comprehensive dental: | Deductible: | N/A |
Ready to sign up for HumanaChoice R0110-003 (Regional PPO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint
SMID: MULTIPLAN_HCIHNDOGMED01PY25_M
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