HumanaChoice SNP-DE H5525-073 (PPO D-SNP)
North Carolina Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)
Monthly Premium
Additional Coverage
Overall Government Star Rating
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Plan Overview
HumanaChoice SNP-DE H5525-073 (PPO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in North Carolina and offered by the health insurance company Humana. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
HumanaChoice SNP-DE H5525-073 (PPO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,850 In and Out-of-network $8,850 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for HumanaChoice SNP-DE H5525-073 (PPO D-SNP) are defined below.
Additional Benefits and Coverage
HumanaChoice SNP-DE H5525-073 (PPO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. HumanaChoice SNP-DE H5525-073 (PPO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. HumanaChoice SNP-DE H5525-073 (PPO D-SNP) includes coverage for the following additional benefits:
Other benefits
Comparing the Quality Score of HumanaChoice SNP-DE H5525-073 (PPO D-SNP) to Other Plans in North Carolina
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, HumanaChoice SNP-DE H5525-073 (PPO D-SNP) received an overall government quality rating of 4.0 stars out of 5 stars.
HumanaChoice SNP-DE H5525-073 (PPO D-SNP) performed better than North Carolina’s State average overall quality score of 3.9 stars.
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
HumanaChoice SNP-DE H5525-073 (PPO D-SNP) received 4 stars for its health plan quality score which is better than the North Carolina State average health plan quality score of 3.7 stars.
HumanaChoice SNP-DE H5525-073 (PPO D-SNP) received 3.5 stars for its drug plan quality score which is the same as the North Carolina State average drug plan quality score of 3.5 stars.
Plan Benefits and Coverage Details
$8,850 In-network
Medical Benefits
Doctor Services
Out-of-network: $0 copay
Out-of-network: $15 copay per visit
Tests, labs, & imaging
Out-of-network: $0-65 copay
Out-of-network: $0-50 copay
Out-of-network: $0-300 copay
Out-of-network: $0-125 copay
Hospital Services
Out-of-network: $370 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: $0-375 copay per visit
Skilled nursing facility
Out-of-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: $300 copay
Therapy services
Out-of-network: $25 copay
Out-of-network: $25 copay
Mental health services
Out-of-network: $45 copay
Out-of-network: $45 copay
Out-of-network: $45 copay
Out-of-network: $45 copay
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: $15 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
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
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