HumanaChoice SNP-DE H5216-292 (PPO D-SNP)

Medicare Plan Details (2022 Plan)

Monthly Premium

by Humana

Additional Coverage

HearingVisionDental

Overall Government Star Rating

4.0

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

Monthly Premium

Health Portion of Premium

Drug Portion of Premium

Health Plan Deductible

Health Plan Max Out-of-Pocket

$5,150 In and Out-of-network
$3,450 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

http://www.humana.com/medicare

Plan Link

http://www.humana.com/medicare

Doctor Services

Primary doctor visit

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

Specialist visit

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

Tests, labs, & imaging

Diagnostic tests & procedures

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

Lab services

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

Diagnostic radiology services (like MRI)

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

Outpatient x-rays

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

Emergency care

$0 copay

Urgent care

$0 copay

Hospital Services

Inpatient hospital coverage

In-network: $0 copay
Out-of-network: $2,524 per stay

Outpatient hospital coverage

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
$188 per day for days 21 through 100

Preventive services

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

Ambulance

Ground ambulance

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

Therapy services

Occupational therapy visit

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

Physical therapy & speech & language therapy visit

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

Mental health services

Outpatient group therapy with a psychiatrist

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

Outpatient individual therapy with a psychiatrist

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

Outpatient group therapy visit

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

Outpatient individual therapy visit

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

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

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

Prosthetics (like braces, artificial limbs)

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

Diabetes supplies

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

Tiers	Initial coverage phase	Gap coverage phase	Catastrophic coverage phase
Preferred Generic	$10.00 copay	Generic drugs : 25% Brand-name drugs : 25%	Generic drugs : $3.95 copay or 5% (whichever costs more) Brand-name drugs : $9.85 copay or 5% (whichever costs more)
Generic	$20.00 copay
Preferred Brand	$47.00 copay
Non-Preferred Drug	$100.00 copay
Specialty Tier	25%

Part B Drugs

Chemotherapy drugs

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

Other Part B drugs

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

Hearing

Hearing exam

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

Fitting/evaluation

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

Hearing aids - All types

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

Preventive Dental

Oral exam

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

Cleaning

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

Fluoride treatment

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

Dental x-rays

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

Comprehensive dental

Non-routine services

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

Diagnostic services

Not covered

Restorative services

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

Endodontics

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

Periodontics

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

Extractions

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

Prosthodontics, other oral/maxillofacial surgery, other services

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

Vision

Routine eye exam

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

Contact lenses

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

Eyeglasses (frames & lenses)

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

Eyeglass frames (only)

Not covered

Eyeglass lenses (only)

Not covered

Upgrades

Not covered

Other benefits

Fitness benefit

Limited coverage

Over the counter drug benefits

Limited coverage

In-home support services

Not covered

Home and bathroom safety devices

Not covered

Meals for short duration

Limited coverage

Annual physical exams

Limited coverage

Telehealth

Limited coverage

Summary rating of health plan quality

4.5

Staying healthy: screenings, tests, & vaccines

Managing chronic (long term) conditions

Member experience with health plan

Member complaints & changes in the health plan's performance

Health plan customer service

Summary rating of drug plan quality

4.5

Drug plan customer service

Member complaints & changes in the drug plan's performance

Member experience with the drug plan

Drug safety & accuracy of drug pricing

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HumanaChoice SNP-DE H5216-292 (PPO D-SNP)

Medicare Plan Details (2022 Plan)

Monthly Premium

by Humana

Additional Coverage

Overall Government Star Rating

Ready to Enroll Online?

Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Plan Details

Medical Benefits

Doctor Services

Tests, labs, & imaging

Hospital Services

Skilled nursing facility

Preventive services

Ambulance

Therapy services

Mental health services

Opioid treatment services

Other services

Prescription Drug Benefits

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

Part B Drugs

Extra Benefits

Hearing

Preventive Dental

Comprehensive dental

Vision

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)

When Can I Sign Up for Medicare?

Ready to Enroll Online?

Medicare Health Plans

Get Advice & Sign Up Help