HumanaChoice R1390-002 (Regional PPO) in Surry, Virginia (2023)
HumanaChoice R1390-002 (Regional PPO) in Surry County, Virginia costs $84/mo. This affordable Regional PPO plan (R1390-002) is a top choice for those living in Surry County with a $360 prescription deductible and out-of-pocket limits at $7,550. Learn more about Medicare Part C by AARP in Surry County, Virginia below.
UPDATED: Sep 23, 2023
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4 out of 5 stars* for plan year 2024
Plan ID: R1390-002
What You Need to Know:
- HumanaChoice R1390-002 (Regional PPO) is a Medicare Advantage Health Maintenance Organization Regional PPO plan.
- It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
- It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
- The plan's monthly premium is $84, which does not include your monthly Medicare Part B premium.
- The annual deductible for this health plan is $360 (Tier 1, 2 and 3 excluded from the Deductible.).
- The plan includes an out-of-pocket maximum of $7,550 per year (in-network).
- HumanaChoice R1390-002 (Regional PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $360 (Tier 1, 2 and 3 excluded from the Deductible.).
- This plan's Part D Initial Coverage Limit is $40.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$84
Monthly Premium
Medicare Plan Features | |||||||||
---|---|---|---|---|---|---|---|---|---|
Monthly Premium: | $84.00 | ||||||||
Part C Premium: | $44.10 | ||||||||
Monthly Premium: | Part C Premium: | Part D Drug Premium: | Part D Supplemental Premium: | Total Part D Premium: | Drug Deductible: | Tiers with No Deductible: | |||
$84.00 | $44.10 | $39.90 | $0 | $39.90 | $360.0 | 1.0 | |||
Gap Coverage: | No | ||||||||
Benchmark: | not below the regional benchmark | ||||||||
Type of Medicare Health: | Enhanced Alternative | ||||||||
Health Plan Type: | Regional PPO | ||||||||
Similar Plan: | R1390-003 | ||||||||
Special Needs Type: | NULL | ||||||||
Chronic Condition: | NULL | ||||||||
Additional Gap Coverage: | No additional gap coverage, only the Donut Hole Discount | ||||||||
Maximum Out-of-Pocket Limit for Parts A & B (Moop): | $7,550 | ||||||||
Annual Deductible: | $360 (Tier 1, 2 and 3 excluded from the Deductible.) | ||||||||
Annual Initial Coverage Limit ICL: | $4,130 | ||||||||
Number of Members enrolled in this plan in Surry, Virginia: | Plans Summary Star Rating: | Customer Service Rating: | Drug Cost Rating: | ||||||
16 members | 3.5 out of 5 Stars. | 4 out of 5 Stars. | 4 out of 5 Stars. | ||||||
Plan Offers Mail Order: | Yes | ||||||||
Plan Health Benefits | |||||||||
Total # of Formulary Drugs: | 3,461 drugs | ||||||||
Number of Members Enrolled in this Plan in Surry, Virginia: | 13,418 members | ||||||||
Number of Drugs Per Tier: | NULL | ||||||||
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: | NULL | ||||||||
Special Needs Plan SNP Eligibility Requirement: | NULL | ||||||||
Monthly Premium Split as Follows: | |||||||||
Part C Premium | Part D Base Premium | Part D Supplemental Premium | Total Premium | ||||||
$44.10 | $39.90 | $0.00 | $84.00 | ||||||
Monthly Premium with Extra Help Low Income Subsidy: | |||||||||
LIS100 Subsidy Total Monthly Premium with LIS Parts CD | LIS25 Subsidy Monthly PartD Premium with LIS | LIS25 Subsidy Total Monthly Premium with LIS Parts CD | LIS50 Monthly PartD Premium with LIS | LIS50 Subsidy Total Monthly Premium with LIS Parts CD | LIS75 Monthly PartD Premium with LIS | LIS75 Subsidy Total Monthly Premium with LIS Parts CD | |||
$53.20 | $32.20 | $76.30 | $24.50 | $68.60 | $16.80 | $60.90 | |||
Formulary Drug Details: | |||||||||
Tier 1 # of Drugs per Tier | Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 2 # of Drugs per Tier | Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 3 # of Drugs per Tier | Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 4 # of Drugs per Tier | Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 5 # of Drugs per Tier | Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase) |
306 | $5.00 | 599 | $15.00 | 788 | $47.00 | 1084 | $99.00 | 684 | 26% |
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