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HumanaChoice H5216-343 (PPO)

Medicare Plan Details (2023 Plan)

Monthly Premium

 

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

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Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

Plan Details

$0
$0
$0
$0
$8,950 In and Out-of-network
$5,900 In-network
No
Yes
Yes
Yes
https://finder.humana.com/finder/medical
http://www.humana.com/medicare

Medical Benefits

Doctor Services

In-network: $0 copay
Out-of-network: $0 copay
In-network: $35 copay per visit
Out-of-network: $35 copay per visit

Tests, labs, & imaging

In-network: $0-85 copay
Out-of-network: $0-85 copay
In-network: $0-50 copay
Out-of-network: $0-85 copay
In-network: $35-295 copay
Out-of-network: $35-345 copay
In-network: $0-95 copay
Out-of-network: $0-85 copay
$110 copay per visit (always covered)
$25 copay per visit (always covered)

Hospital Services

In-network: $345 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: $345 per day for days 1 through 5
$0 per day for days 6 through 90
In-network: $35-345 copay per visit
Out-of-network: $35-345 copay per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$196 per day for days 21 through 51
$0 per day for days 52 through 100
Out-of-network: $0 per day for days 1 through 20
$196 per day for days 21 through 66
$0 per day for days 67 through 100

Preventive services

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

Ambulance

In-network: $300 copay
Out-of-network: $300 copay

Therapy services

In-network: $10-35 copay
Out-of-network: $10-35 copay
In-network: $10-35 copay
Out-of-network: $10-35 copay

Mental health services

In-network: $35 copay
Out-of-network: $35 copay
In-network: $35 copay
Out-of-network: $35 copay
In-network: $35 copay
Out-of-network: $35 copay
In-network: $35 copay
Out-of-network: $35 copay

Opioid treatment services

Covered

Other services

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

Prescription Drug Benefits

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

Part B Drugs

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

Extra Benefits

Hearing

In-network: $35 copay
Out-of-network: $35 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0-299 copay
Out-of-network: $0-299 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

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
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

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

Health Plan Star Ratings

(government star ratings are out of 5 stars)
 4.5
 4
 4
 4
 4
 5

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