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HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
Medicare Plan Details (2022 Plan)
Monthly Premium

by Humana
Additional Coverage
HearingVisionDental
Overall Government Star Rating
4.0out 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
Plan Details
$0
$0
$0
$0
$5,150 In and Out-of-network
$3,450 In-network
$3,450 In-network
No
Yes
Yes
Yes
Medical Benefits
Doctor Services
In-network: $0 copay
Out-of-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
In-network: $0 copay
Out-of-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Tests, labs, & imaging
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
$0 copay
$0 copay
Hospital Services
In-network: $0 copay
Out-of-network: $2,524 per stay
Out-of-network: $2,524 per stay
In-network: $0 copay
Out-of-network: 20% coinsurance per visit
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
$188 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$188 per day for days 21 through 100
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Therapy services
In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Covered
Other services
In-network: $0 copay
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: $0 copay
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: $0 copay
Out-of-network: $0 copay or 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 | $10.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
Generic | $20.00 copay | ||
Preferred Brand | $47.00 copay | ||
Non-Preferred Drug | $100.00 copay | ||
Specialty Tier | 25% |
Part B Drugs
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
Extra Benefits
Hearing
In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Preventive Dental
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Not covered
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-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
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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