HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
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
$8,300 In-network
Medical Benefits
Doctor Services
Out-of-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Tests, labs, & imaging
Out-of-network: 20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Hospital Services
Out-of-network: $2,050 per stay
Out-of-network: 20% coinsurance per visit
Skilled nursing facility
Out-of-network: $0 per day for days 1 through 20
$196 per day for days 21 through 100
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: 20% coinsurance
Therapy services
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Other services
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Out-of-network: $0 copay or 20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic |
Brand-name drugs :
|
Brand-name drugs :
| |
| Generic | |||
| Preferred Brand | |||
| Non-Preferred Drug | |||
| Specialty Tier |
Part B Drugs
Out-of-network: $0 copay or 20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
Extra Benefits
Hearing
Out-of-network: 20% coinsurance
Out-of-network: $0 copay
Out-of-network: $0 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
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
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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