HumanaChoice R5361-002 (PPO) Medicare Advantage Plan R5361-002 • 2027
- Monthly Premium
- $87.00Plus Part B premium.
- Medical Deductible
- $100
- Maximum Out-of-Pocket
- $7700.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 1,634 beneficiaries
HumanaChoice R5361-002 (Regional PPO) Introduction
This Medicare Advantage Regional PPO plan, HumanaChoice R5361-002, is offered by Humana and uses a Preferred Provider Organization (PPO) provider network. It comes with prescription drug coverage. For the 2027 plan year, the monthly premium is $87.00, the medical deductible is $100, and the in-network maximum out-of-pocket is $7700.00. The plan is identified by CMS Plan ID R5361-002. The 2027 Part D prescription drug deductible is $700.00.
Plan Benefits
Cost-sharing for HumanaChoice R5361-002 includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan R5361-002.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: 40% coinsurance |
In-network: $0 copay Out-of-network: 40% coinsurance |
| Specialist | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 50% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay |
| Telehealth benefit | In-network: $0-$40 copay, 20% coinsurance | In-network: $0-$40 copay, 20% coinsurance |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | Not covered | Not covered |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$345 copay Out-of-network: $0 copay, 50% coinsurance |
In-network: $0-$335 copay, 20% coinsurance Out-of-network: $0 copay, 50% coinsurance |
| Lab services | In-network: $0 copay Out-of-network: $40 copay, 50% coinsurance |
In-network: $0-$20 copay, 20% coinsurance Out-of-network: 50% coinsurance |
| Outpatient x-rays | In-network: $0-$40 copay, 20% coinsurance Out-of-network: $40 copay, 40%-50% coinsurance |
In-network: $0-$40 copay, 20% coinsurance Out-of-network: 40%-50% coinsurance |
| Diagnostic tests and procedures | In-network: $0-$100 copay, 20% coinsurance Out-of-network: $40 copay, 40%-50% coinsurance |
In-network: $0-$40 copay, 20% coinsurance Out-of-network: 40%-50% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $115 copay | $115 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | $40 copay | $40 copay |
| Inpatient hospital care | In-network: Tier 1 $560 per day for days 1-4 $0 per day for days 5-90 $0 per stay Out-of-network: 50% per stay |
In-network: Tier 1 $600 per day for days 1-4 $0 per day for days 5-90 $0 per stay Out-of-network: 50% per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 Out-of-network: 50% per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 50% per stay |
| Ground ambulance | In-network: $325 copay Out-of-network: $325 copay |
In-network: $335 copay Out-of-network: 20% coinsurance |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $35 copay Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Outpatient group therapy | In-network: $35 copay Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $560 per day for days 1-4 $0 per day for days 5-90 $0 per stay Out-of-network: 50% per stay |
In-network: Tier 1 $600 per day for days 1-4 $0 per day for days 5-90 $0 per stay Out-of-network: 50% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $35 copay Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Occupational therapy | In-network: $35 copay Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay, 10%-20% coinsurance Out-of-network: 10%-50% coinsurance |
In-network: $0 copay, 10%-20% coinsurance Out-of-network: 50% coinsurance |
| Durable medical equipment | In-network: 16% coinsurance Out-of-network: 50% coinsurance |
In-network: $0 copay, 20% coinsurance Out-of-network: 20% coinsurance |
| Prosthetics | In-network: 16% coinsurance Out-of-network: 50% coinsurance |
In-network: 20% coinsurance Out-of-network: 50% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Dental x-rays | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Cleaning | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Periodontics | In-network: $0 copay Out-of-network: $0 copay |
Not covered |
| Endodontics | Not covered | Not covered |
| Restorative services | Not covered | Not covered |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | Not covered | Not covered |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: 95% coinsurance |
In-network: $0 copay Out-of-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay Out-of-network: 95% coinsurance |
In-network: $0 copay Out-of-network: $0 copay |
| Prescription hearing aids | In-network: $575-$750 copay Out-of-network: 95% coinsurance |
In-network: $699-$999 copay Out-of-network: $699-$999 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by HumanaChoice R5361-002 as a Part B benefit.
Prescription Drug Coverage
HumanaChoice R5361-002 includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $16.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $16.00 |
| Low-Income Premium Subsidy: | $7.61 |
| Low-Income Premium Subsidy Paid by CMS: | $6.80 |
| Low-Income Subsidy Premium: | $9.20 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Humana starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, HumanaChoice R5361-002 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $4.00 copay | Coming soon |
| Preferred Brand | 19% coinsurance | Coming soon |
| Non-Preferred Drug | 33% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: R5361)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Humana
- Website
- Humana Plan Page
- Providers
- Humana Providers Page
- Formulary
- Humana Formulary Page
- Pharmacy
- Humana Pharmacy Page
- New Member Health Plan Help
- (888)873-0686
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (888)873-0686
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
HumanaChoice R5361-002 (R5361-002-0) is available in the following locations:
Illinois Counties Served
- Adams
- Alexander
- Bond
- Boone
- Brown
- Bureau
- Calhoun
- Carroll
- Cass
- Champaign
- Christian
- Clark
- Clay
- Clinton
- Coles
- Cook
- Crawford
- Cumberland
- Dekalb
- Dewitt
- Douglas
- Dupage
- Edgar
- Edwards
- Effingham
- Fayette
- Ford
- Franklin
- Fulton
- Gallatin
- Greene
- Grundy
- Hamilton
- Hancock
- Hardin
- Henderson
- Henry
- Iroquois
- Jackson
- Jasper
- Jefferson
- Jersey
- Jo Daviess
- Johnson
- Kane
- Kankakee
- Kendall
- Knox
- La Salle
- Lake
- Lawrence
- Lee
- Livingston
- Logan
- Macon
- Macoupin
- Madison
- Marion
- Marshall
- Mason
- Massac
- Mcdonough
- McHenry
- Mclean
- Menard
- Mercer
- Monroe
- Montgomery
- Morgan
- Moultrie
- Ogle
- Peoria
- Perry
- Piatt
- Pike
- Pope
- Pulaski
- Putnam
- Randolph
- Richland
- Rock Island
- Saint Clair
- Saline
- Sangamon
- Schuyler
- Scott
- Shelby
- Stark
- Stephenson
- Tazewell
- Union
- Vermilion
- Wabash
- Warren
- Washington
- Wayne
- White
- Whiteside
- Will
- Williamson
- Winnebago
- Woodford
Wisconsin Counties Served
- Ashland
- Barron
- Bayfield
- Buffalo
- Burnett
- Calumet
- Chippewa
- Columbia
- Dane
- Dodge
- Door
- Dunn
- Eau Claire
- Florence
- Fond Du Lac
- Forest
- Grant
- Green
- Green Lake
- Iowa
- Iron
- Juneau
- Kenosha
- Kewaunee
- La Crosse
- Lafayette
- Langlade
- Lincoln
- Manitowoc
- Marathon
- Marinette
- Marquette
- Menominee
- Milwaukee
- Oconto
- Oneida
- Outagamie
- Ozaukee
- Pepin
- Pierce
- Polk
- Portage
- Price
- Racine
- Rock
- Rusk
- Saint Croix
- Sauk
- Sawyer
- Shawano
- Sheboygan
- Taylor
- Trempealeau
- Vernon
- Vilas
- Walworth
- Washburn
- Waukesha
- Waupaca
- Waushara
- Wood
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About HumanaChoice R5361-002 (Regional PPO)
What is the monthly premium for HumanaChoice R5361-002 (Regional PPO)?
The 2027 monthly premium is $87.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan R5361-002?
For 2027, the in-network maximum out-of-pocket is $7700.00. The plan pays 100% of covered in-network services beyond this amount.
What is the CMS star rating for this plan?
CMS rates this plan at ★3.5 out of 5 stars for 2027.
What is the total enrollment for plan R5361-002?
Total enrollment is 1,634 beneficiaries based on the latest CMS data.
What is the Part D deductible for plan R5361-002?
The plan’s Part D deductible is $700.00, applied to covered prescription drug costs.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Humana (official source) | http://www.humana.com/medicare | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.