HumanaChoice R7220-002 (Regional PPO) R7220:002-0 Plan Details

In this article...
  • Learn more about HumanaChoice R7220-002 (Regional PPO) R7220:002-0 Plan Details, including how much you can expect to pay for coinsurance, deductibles, premiums and copays for various services covered by the plan.

Arizona Counties Served

Pinal County

Yavapai County

Mohave County

Yuma County

Santa Cruz County

Pima County County

Navajo County

Maricopa County

La Paz County

Greenlee County

Graham County

Gila County

Coconino County

Cochise County

Apache County

Plan Details and Plan Costs

HumanaChoice R7220-002 (Regional PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered in Arizona by Humana. The plan ID is R7220:002-0.

  • Monthly Premium: $52
  • Plan Deductible: $0.00
  • Out of Pocket Spending Max: $6700

Primary Care Doctor Visit

In Network: $15 Copayment

Out of Network: 50% Coinsurance

Specialist Doctor Visit

In Network:

  • $45 Copayment for Physician Specialist Office Visit

Out of Network:

  • 50% Coinsurance

Inpatient Hospital Care

In Network:

  • $289.00 per day for days 1 to 6
  • $0.00 per day for days 7 to 90
  • Prior Authorization Required for Acute Hospital Services

Out of Network:

  • 50% Coinsurance for Acute Hospital Services per Stay 

Urgent Care

Cost share amount will apply based on the setting where the service is received.

In Network:

  • Primary Care Physician (PCP): $15.00 
  • Specialist: $45.00
  • Urgent Care Center: $25.00 

Out-Of-Network

  • PCP: 50% coinsurance
  • Specialist: 50% coinsurance
  • Urgent Care Center: 50% coinsurance

Copayment for Worldwide Urgent Coverage: $90.00

Emergency Room (ER) Visits

In Network:

  • Copayment for Emergency Care: $90.00
  • Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours.

Worldwide Coverage:

  • Copayment for Worldwide Emergency Coverage $0.00
  • Copayment for Worldwide Emergency Transportation $0.00

Ambulance Transportation

In Network:

  • Ground Ambulance: $265 copayment
  • Air Ambulance: 20% Coinsurance
  • Please see Evidence of Coverage for Prior Authorization rules

Out of Network:

  • Ground Ambulance: $265 copayment
  • Air Ambulance: 20% Coinsurance

Additional Covered Health Care Services and Medical Supplies

HumanaChoice R7220-002 (Regional PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Home Health Care

In Network: $0.00 Copay

  • Prior Authorization Required for Home Health Services

Out of Network: 50% Coinsurance 

Skilled Nursing Facility (SNF) Care

In Network:

  • $0.00 per day for days 1 to 20
  • $178.00 per day for days 21 to 100
  • Prior Authorization Required for Skilled Nursing Facility Services

Out of Network:

  • 50% Coinsurance 

Medical Diagnostic Tests, Labs and Radiology Services

Outpatient Diagnostic Procedures, Tests and Lab Services:

  • Copayment for Medicare-covered Diagnostic Procedures/Tests: $0.00 to $45.00
  • Coinsurance for Medicare-covered Diagnostic Procedures/Tests: 20%
  • Copayment for Medicare-covered Lab Services: $0.00 to $25.00
  • Coinsurance for Medicare-covered Lab Services: 20%
  • Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Service

Outpatient Diagnostic and Therapeutic Radiology Services:

  • Copayment for Medicare-covered Diagnostic Radiological Services: $15.00 to $264.00
  • Coinsurance for Medicare-covered Diagnostic Radiological Services: 20%
  • Copayment for Medicare-covered Therapeutic Radiological Services: $45.00
  • Coinsurance for Medicare-covered Therapeutic Radiological Services: 20%
  • Copayment for Medicare-covered X-Ray Services: $15.00 to $45.00
  • Coinsurance for Medicare-covered X-Ray Services: 20%
  • Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services

Diabetes Supplies, Training, Nutrition Therapy and Monitoring

In-Network:

  • Copayment for Medicare-covered Diabetic Supplies $0.00
  • Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20%
  • Prior Authorization Required for Diabetic Supplies and Services
    Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage)

Durable Medical Equipment (DME)

Diabetic Supplies:

  • Copayment for Medicare-covered Diabetic Supplies: $0.00
  • Coinsurance for Medicare-covered Diabetic Supplies: 10% to 20%
  • Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts: $0.00
  • Prior Authorization Required for Diabetic Supplies and Services

Diabetic Supplies and Services limited to those from specified manufacturers (Please see Evidence of Coverage).

Durable Medical Equipment (DME)

In Network:

  • Coinsurance for Medicare-covered Durable Medical Equipment: 20%
  • Prior Authorization Required for Durable Medical Equipment

Out of Network:

  • Coinsurance for Medicare Covered Durable Medical Equipment: 50%

Chiropractic Services

In Network:

  • Copayment for Medicare-covered Chiropractic Services: $20.00
  • Prior Authorization Required for Chiropractic Services

Out of Network:

  • Coinsurance for Medicare Covered Chiropractic Services: 50%

Mental Health Inpatient Care

In Network:

  • $254.00 per day for days 1 to 6
  • $0.00 per day for days 7 to 90
  • Prior Authorization Required for Psychiatric Hospital Services

Out of Network:

  • Coinsurance for Psychiatric Hospital Services per Stay: 50%

Mental Health Outpatient Care

In Network:

  • Copayment for Medicare-covered Individual Sessions: $20
  • Copayment for Medicare-covered Group Sessions: $20
  • Prior Authorization Required for Outpatient Mental Health Services

Out of Network:

  • Coinsurance for Medicare Covered Individual Sessions: 50%
  • Coinsurance for Medicare Covered Group Sessions: 50%

Outpatient Substance Abuse Care

In Network:

  • Copayment for Medicare-covered Individual Sessions: $20
  • Copayment for Medicare-covered Group Sessions: $20
  • Prior Authorization Required for Outpatient Substance Abuse Services

Podiatry Services

In Network:

  • Copayment for Medicare-Covered Podiatry Services: $45.00
  • Copayment for Routine Foot Care: $0.00
  • Maximum 12 visits every year
  • Prior Authorization Required for Podiatry Services

Over-the-Counter (OTC) Items

Copayment for Over-The-Counter (OTC) Items: $0.00

  • Maximum Plan Benefit of $50.00 every three months
  • Nicotine Replacement Therapy (NRT) offered as a Part C OTC benefit

Dental Benefits

The following dental services are covered from in-network providers.

Comprehensive Dental Care

Medicare-Covered Benefits:

  • Copayment for Medicare-covered Benefits: $45.00
  • Prior Authorization Required for Comprehensive Dental

Vision Benefits

The following vision services are covered from in-network providers.

Eye Exams

Medicare-Covered Benefits:

  • Copayment for Medicare Covered Benefits: $0.00 to $45.00

Routine Eye Exams:

  • Copayment for Routine Eye Exams: $0.00
  • Maximum 1 Routine Eye Exam every year
  • Maximum Plan Benefit of $40.00 every year for in and out of network services combined
  • Prior Authorization Required for Eye Exams

Eyewear

Medicare-Covered Benefits:

  • Copayment for Medicare-Covered Benefits: $0.00
  • Prior Authorization Required for Eyewear

Hearing Benefits

The following vision services are covered from in-network providers.

Hearing Exams

Medicare-Covered Benefits:

  • Copayment for Medicare Covered Benefits: $45.00
  • Prior Authorization Required for Hearing Exams

Preventive Services and Health/Wellness Education Programs

The following preventive services and wellness education programs are covered from in-network providers with $0.00 copay for Medicare Covered Preventive Services.

  • Abdominal aortic aneurysm screening
  • Alcohol misuse screenings & counseling
  • Bone mass measurements (bone density)
  • Cardiovascular disease screenings
  • Cardiovascular disease (behavioral therapy)
  • Cervical & vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screenings
  • Diabetes screenings
  • Diabetes self-management training
  • Glaucoma tests
  • Hepatitis B (HBV) infection screening
  • Hepatitis C screening test
  • HIV screening
  • Lung cancer screening
  • Mammograms (screening)
  • Nutrition therapy services
  • Obesity screenings & counseling
  • One-time Welcome to Medicare preventive visit
  • Prostate cancer screenings(PSA)
  • Sexually transmitted infections screening & counseling
  • Tobacco use cessation

Shots:

  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots

Prescription Drug Costs and Coverage

The HumanaChoice R7220-002 (Regional PPO) plan offers the following prescription drug coverage in Arizona, with an annual drug deductible of $430 per year.

Preferred Generic Drugs

  • Preferred Retail Cost Sharing (30 Day Supply) $7.00
  • Preferred Mail Order Cost Sharing (90 Day Supply) $0.00
  • Standard Retail Cost Sharing (30 Day Supply) $19.00
  • Standard Mail Order Cost Sharing (90 Day Supply) $57.00

Generic Drugs

  • Preferred Retail Cost Sharing (30 Day Supply) $15.00
  • Preferred Mail Order Cost Sharing (90 Day Supply) $0.00
  • Standard Retail Cost Sharing (30 Day Supply) $20.00
  • Standard Mail Order Cost Sharing (90 Day Supply) $60.00

Preferred Brand Name Drugs

  • Preferred Retail Cost Sharing (30 Day Supply) $47.00
  • Preferred Mail Order Cost Sharing (90 Day Supply) $131.00
  • Standard Retail Cost Sharing (30 Day Supply) $47.00
  • Standard Mail Order Cost Sharing (90 Day Supply) $141.00

Non-Preferred Drugs

  • Preferred Retail Cost Sharing (30 Day Supply) $100.00
  • Preferred Mail Order Cost Sharing (90 Day Supply) $290.00
  • Standard Retail Cost Sharing (30 Day Supply) $100.00
  • Standard Mail Order Cost Sharing (90 Day Supply) $300.00

Specialty Tier Drugs

  • Preferred Retail Cost Sharing (30 Day Supply) 25%
  • Standard Retail Cost Sharing (30 Day Supply) 25%
Read More
Smiling couple outdoors with sun in the background
How do Medigap plans and Medicare Advantage plans differ? How can you decide which type of plan is ...
Happy Couple Visiting With Friends
How much does Medicare cost? Are there affordable options available to help seniors with out-of-pocket ...
Man uses laptop computer at home in his kitchen
Medicare.gov is an important resource for Medicare enrollees. Learn about some of the features the ...