HumanaChoice SNP-DE H5216-332 (PPO D-SNP)

Medicare Plan Details (2023 Plan)


Monthly Premium

 

by Humana
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 4.5
out of 5 stars

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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
$12,450 In and Out-of-network
$8,300 In-network
No
Yes
Yes
Yes

Doctor Services

In-network: $0 copay
Out-of-network: 20% coinsurance per visit
In-network: $0 copay
Out-of-network: 20% coinsurance per visit

Tests, labs, & imaging

In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
$0 copay
$0 copay

Hospital Services

In-network: $0 copay
Out-of-network: $1,650 per stay
In-network: $0 copay
Out-of-network: 20% coinsurance per visit

Skilled nursing facility

In-network: $0 copay
Out-of-network: $0 per day for days 1 through 20
$196 per day for days 21 through 100

Preventive services

In-network: $0 copay
Out-of-network: $0 copay

Ambulance

In-network: $0 copay
Out-of-network: 20% coinsurance

Therapy services

In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance

Mental health services

In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance

Opioid treatment services

Covered

Other services

In-network: $0 copay
Out-of-network: 20% coinsurance per item
In-network: $0 copay
Out-of-network: 20% coinsurance per item
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance per item

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$4.15 copay or 5% (whichever costs more)

Brand-name drugs :
$10.35 copay or 5% (whichever costs more)

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance

Hearing

In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

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
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

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
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
In-network: $0 copay
Out-of-network: $0 copay

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
Not covered
Limited coverage
Not covered
Limited coverage
Limited coverage
Limited coverage
 4.5
 4
 4
 4
 4
 5
 3.5
 5
 3
 4
 3

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