HumanaChoice H5525-042 (PPO)
Medicare Plan Details (2023 Plan)
Monthly Premium
by Humana
Additional Coverage
Overall Government Star Rating
4.0Ready 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
$7,550 In-network
Medical Benefits
Doctor Services
Out-of-network: $0-50 copay per visit
Out-of-network: $40-100 copay per visit
Tests, labs, & imaging
Out-of-network: $20-110 copay or 20% coinsurance
Out-of-network: $0-35 copay or 20% coinsurance
Out-of-network: $0-425 copay or 20% coinsurance
Out-of-network: $20-110 copay or 20% coinsurance
Hospital Services
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Out-of-network: $490 per day for days 1 through 4
$0 per day for days 5 through 90
Out-of-network: $0-465 copay per visit
Skilled nursing facility
$184 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: $290 copay
Therapy services
Out-of-network: $0-50 copay
Out-of-network: $0-50 copay
Mental health services
Out-of-network: $40-100 copay
Out-of-network: $40-100 copay
Out-of-network: $40-100 copay
Out-of-network: $40-100 copay
Opioid treatment services
Other services
Out-of-network: 19% coinsurance per item
Out-of-network: $0-35 copay or 20% coinsurance per item
Out-of-network: $0-35 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 | $7.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
| Generic | $17.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | $100.00 copay | ||
| Specialty Tier | 29% |
Part B Drugs
Out-of-network: $0-35 copay or 20% coinsurance
Out-of-network: $0-35 copay or 20% coinsurance
Extra Benefits
Hearing
Out-of-network: $40-100 copay
Out-of-network: $0 copay
Out-of-network: $399-999 copay
Preventive Dental
Comprehensive dental
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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