HumanaChoice H5216-138 (PPO)

Medicare Plan Details (2023 Plan)


Monthly Premium

 

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

Ready to Enroll Online?


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
$375 annual deductible
$7,550 In and Out-of-network
$4,800 In-network
No
Yes
Yes
Yes

Doctor Services

In-network: $0 copay
Out-of-network: $45 copay per visit
In-network: $50 copay per visit
Out-of-network: $65 copay per visit

Tests, labs, & imaging

In-network: $0-100 copay
Out-of-network: $45-65 copay or 40% coinsurance
In-network: $0-50 copay
Out-of-network: $45-65 copay or 40% coinsurance
In-network: $0-400 copay
Out-of-network: $45-65 copay or 40% coinsurance
In-network: $0-100 copay
Out-of-network: $45-65 copay or 40% coinsurance
$95 copay per visit (always covered)
$25 copay per visit (always covered)

Hospital Services

In-network: $800 per stay
Out-of-network: 40% per stay
In-network: $50-450 copay per visit
Out-of-network: 40% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$196 per day for days 21 through 100
Out-of-network: 40% per stay

Preventive services

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

Ambulance

In-network: $290 copay
Out-of-network: $290 copay

Therapy services

In-network: $40 copay
Out-of-network: 40% coinsurance
In-network: $40 copay
Out-of-network: 40% coinsurance

Mental health services

In-network: $45 copay
Out-of-network: 40% coinsurance
In-network: $45 copay
Out-of-network: 40% coinsurance
In-network: $45 copay
Out-of-network: 40% coinsurance
In-network: $45 copay
Out-of-network: 40% coinsurance

Opioid treatment services

Covered

Other services

In-network: 15% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: 15% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: $0 copay or 10-20% coinsurance per item
Out-of-network: 40% coinsurance per item

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

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$0.00 copay$0.00 copay


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

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

Generic$5.00 copay$5.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier28%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

In-network: 13-20% coinsurance
Out-of-network: 13-20% coinsurance
In-network: 13-20% coinsurance
Out-of-network: 13-20% coinsurance

Hearing

In-network: $50 copay
Out-of-network: $65 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0-599 copay
Out-of-network: $0-599 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

Not covered
In-network: $0 copay
Out-of-network: $0 copay
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
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
 4.5
 4
 4
 4
 4
 5
 3.5
 5
 3
 4
 3

When Can I Sign Up for Medicare?

Enter your birthday month and year to learn when you can sign up for different Medicare plan options.

 

 


Ready to Enroll Online?

Please Support Our Sponsor

Advertisement

Medicare Health Plans

Get Advice & Sign Up Help
TTY 711

Speak with a Licensed Insurance Agent

Mon-Fri: 8am-9pm ET

Medicare65quote

  • Medicare Advantage Plans
  • Medicare Prescription Drug Plans
  • Medicare Supplement Insurance Plans

No obligation to enroll. Find your plan online or speak with a licensed insurance agent to get help signing up for the right plan for you! See www.medicare65quote.com for our Third-Party Marketing Organization disclaimer.

Related Articles
Best Maine Medicare Advantage Health Insurance Companies for 2023

In this article we rank Maine Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.

Read more →

New Maine Medicare Advantage Health Insurance Companies for 2023

The Medicare landscape in Maine is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in Maine.

Read more →