HumanaChoice H5216-138 (PPO)
Medicare Plan Details (2023 Plan)
Monthly Premium
by Humana
Additional Coverage
Overall Government Star Rating
4.5Ready 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
Plan Details
$4,800 In-network
Medical Benefits
Doctor Services
Out-of-network: $45 copay per visit
Out-of-network: $65 copay per visit
Tests, labs, & imaging
Out-of-network: $45-65 copay or 40% coinsurance
Out-of-network: $45-65 copay or 40% coinsurance
Out-of-network: $45-65 copay or 40% coinsurance
Out-of-network: $45-65 copay or 40% coinsurance
Hospital Services
Out-of-network: 40% per stay
Out-of-network: 40% coinsurance per visit
Skilled nursing facility
$196 per day for days 21 through 100
Out-of-network: 40% per stay
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: $290 copay
Therapy services
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Mental health services
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Opioid treatment services
Other services
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Out-of-network: 40% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
Brand-name drugs :
|
| Generic | $5.00 copay | $5.00 copay | |
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | $100.00 copay | ||
| Specialty Tier | 28% | ||
| 1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. | |||
Part B Drugs
Out-of-network: 13-20% coinsurance
Out-of-network: 13-20% coinsurance
Extra Benefits
Hearing
Out-of-network: $65 copay
Out-of-network: $0 copay
Out-of-network: $0-599 copay
Preventive Dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Out-of-network: $0 copay
Vision
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Other benefits
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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