HumanaChoice H5216-222 (PPO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

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

State: Idaho

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

 

$74
$52
$23
$0
$10,000 In and Out-of-network
$6,700 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $10 per visit
Out-of-network: 50% per visit
In-network: $35 per visit
Out-of-network: 50% per visit

Tests, labs, & imaging

In-network: $0-40
Out-of-network: 50%
In-network: $0-15
Out-of-network: 50%
In-network: $35-390
Out-of-network: 50%
In-network: $0-15
Out-of-network: 50%
$90 per visit (always covered)
$10-35 or 50% per visit (always covered)

Hospital Services

In-network: $390 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: 50% per stay
In-network: $5-390 per visit
Out-of-network: 50% per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 60
$0 per day for days 61 through 100
Out-of-network: 50% per stay

Preventive services

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

Ambulance

In-network: $265
Out-of-network: $265

Therapy services

In-network: $40 or 20%
Out-of-network: 50%
In-network: $40 or 20%
Out-of-network: 50%

Mental health services

In-network: $35
Out-of-network: 50%
In-network: $35
Out-of-network: 50%
In-network: $35
Out-of-network: 50%
In-network: $35
Out-of-network: 50%

Opioid treatment services

Covered

Other services

In-network: 20% per item
Out-of-network: 25% per item
In-network: 20% per item
Out-of-network: 50% per item
In-network: $0 or 10-20% per item
Out-of-network: 50% 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 :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier28%

Part B Drugs

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

Extra Benefits

Hearing

In-network: $35
Out-of-network: 50%
In-network: $0 copay
Out-of-network: $0 copay
In-network: $699-999
Out-of-network: $699-999

Preventive Dental

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

Comprehensive dental

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

Vision

In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
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