HumanaChoice Florida H5216-061 (PPO)


Medicare Plan Details

2021 Plan
Monthly Premium
(select county for price)

 

by Humana
Additional Coverage
Hearing Dental
Overall Government Star Rating
 4.0
out of 5 stars

State: Florida

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

 

$0
$0
$0
$0
$10,000 In and Out-of-network
$6,700 In-network
No
Yes
No
Yes

Medical Benefits

Doctor Services

In-network: $5 copay per visit
Out-of-network: $65 copay per visit
In-network: $45 copay per visit
Out-of-network: $65 copay per visit

Tests, labs, & imaging

In-network: $0-200 copay or 20% coinsurance
Out-of-network: $0-65 copay or 50% coinsurance
In-network: $0-15 copay or 20% coinsurance
Out-of-network: $65 copay or 50% coinsurance
In-network: $45-250 copay or 20% coinsurance
Out-of-network: $65 copay or 50% coinsurance
In-network: $5-50 copay or 20% coinsurance
Out-of-network: $65 copay or 50% coinsurance
$90 copay per visit (always covered)
$5-65 copay per visit (always covered)

Hospital Services

In-network: $318 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91 and beyond
Out-of-network: $495 per day for days 1 through 27
$0 per day for days 28 through 90
In-network: $50-250 copay or 20% coinsurance per visit
Out-of-network: $65 copay or 50% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$160 per day for days 21 through 100
Out-of-network: $250 per day for days 1 through 58
$0 per day for days 59 through 100

Preventive services

In-network: $0 copay
Out-of-network: $0 copay or 50% coinsurance

Ambulance

In-network: $240 copay
Out-of-network: $240 copay

Therapy services

In-network: $10-40 copay
Out-of-network: $65 copay or 50% coinsurance
In-network: $10-40 copay
Out-of-network: $65 copay or 50% coinsurance

Mental health services

In-network: $40 copay
Out-of-network: $65 copay
In-network: $40 copay
Out-of-network: $65 copay
In-network: $40 copay
Out-of-network: $65 copay
In-network: $40 copay
Out-of-network: $65 copay

Opioid treatment services

Covered

Other services

In-network: 18% coinsurance per item
Out-of-network: 30% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 25% coinsurance per item
In-network: $0 copay or 20% coinsurance per item
Out-of-network: 50% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$10.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$3.70 copay or 5% (whichever costs more)

Brand-name drugs :
$9.20 copay or 5% (whichever costs more)

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier29%

Part B Drugs

In-network: 20% coinsurance
Out-of-network: 20-50% coinsurance
In-network: 20% coinsurance
Out-of-network: 20-50% coinsurance

Extra Benefits

Hearing

In-network: $45 copay
Out-of-network: $65 copay
Not covered
Not covered
Not covered
Not covered

Preventive Dental

In-network: $0 copay
Out-of-network: 50% coinsurance
In-network: $0 copay
Out-of-network: 50% coinsurance
Not covered
In-network: $0 copay
Out-of-network: 50% coinsurance

Comprehensive dental

Not covered
Not covered
In-network: 0% coinsurance
Out-of-network: 50% coinsurance
Not covered
In-network: 0% coinsurance
Out-of-network: 50% coinsurance
Not covered
Not covered

Vision

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
 3.5
 4
 4
 4
 4
 5
 3.5
 4
 4
 3
 4

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