Call now to get help signing up for plans from licensed insurance agents!
No obligation to enroll. Mon-Fri: 8am-9pm, Sat: 9am-8pm ET
TTY 711
Ready to Enroll Online?
HumanaChoice SNP-DE H5525-046 (PPO D-SNP)
Ohio Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)
Monthly Premium
Your Cost
$41
by Humana
Additional Coverage
HearingVisionDental
Overall Government Star Rating
4.0
out of 5 stars
Ready to Enroll Online?
Plan Overview
Plan Name
HumanaChoice SNP-DE H5525-046 (PPO D-SNP)
Insurance Carrier
Humana
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
PPO
HumanaChoice SNP-DE H5525-046 (PPO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Ohio 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
Monthly Premium
$41
Annual Deductible
$0 or $240 per year for some in-network and out-of-network services.
Max Out-of-Pocket
$8,850
Primary doctor visit
0% or 20% coinsurance per visit
Specialist visit
0% or 20% coinsurance per visit
ER visit
$0 or $100 copay per visit (always covered)
Ambulance
0% or 20% coinsurance
HumanaChoice SNP-DE H5525-046 (PPO D-SNP) has a monthly premium cost of $41 per month, with an annual deductible of $0 or $240 per year for some in-network and out-of-network services. and a maximum out of pocket cost sharing of $13,300 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 H5525-046 (PPO D-SNP) are defined below.
Additional Benefits and Coverage
Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing
HumanaChoice SNP-DE H5525-046 (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 H5525-046 (PPO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. HumanaChoice SNP-DE H5525-046 (PPO D-SNP) includes coverage for the following additional benefits:
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
Comparing the Quality Score of HumanaChoice SNP-DE (PPO D-SNP) to Other Plans in Ohio
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 (PPO D-SNP) received an overall government quality rating of 4.0 stars out of 5 stars.
HumanaChoice SNP-DE (PPO D-SNP) performed better than Ohio’s State average overall quality score of 3.7 stars.
This Plan’s 5-star Gov’t Quality Score
Ohio State Average Score
Overall Government 5 Star Quality Rating
4.0
3.7
Summary rating of health plan quality
4
3.8
Staying healthy: screenings, tests, & vaccines
3
3.0
Managing chronic (long term) conditions
3
3.0
Member experience with health plan
4
3.9
Member complaints & changes in the health plan's performance
4
3.4
Health plan customer service
5
4.6
Summary rating of drug plan quality
3.5
3.4
Drug plan customer service
5
4.2
Member complaints & changes in the drug plan's performance
3
3.4
Member experience with the drug plan
4
3.6
Drug safety & accuracy of drug pricing
3
3.0
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 (PPO D-SNP) received 4 stars for its health plan quality score which is better than the Ohio State average health plan quality score of 3.8 stars.
HumanaChoice SNP-DE (PPO D-SNP) received 3.5 stars for its drug plan quality score which is better than the Ohio State average drug plan quality score of 3.4 stars.
Plan Benefits and Coverage Details
Monthly Premium
$41
Health Portion of Premium
$0
Drug Portion of Premium
$41
Health Plan Deductible
$0 or $240 per year for some in-network and out-of-network services.
In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Specialist visit
In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0 copay or 20% coinsurance
Out-of-network: 20% coinsurance
Lab services
In-network: $0 copay or 20% coinsurance
Out-of-network: 20% coinsurance
Diagnostic radiology services (like MRI)
In-network: 0% or 15-20% coinsurance
Out-of-network: 15-20% coinsurance
Outpatient x-rays
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Emergency care
$0 or $100 copay per visit (always covered)
Urgent care
0% or 20% coinsurance per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: $0 or $2,080 per stay
Out-of-network: $2,080 per stay
Outpatient hospital coverage
In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$0 or $203 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance
Ambulance
Ground ambulance
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Therapy services
Occupational therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Physical therapy & speech & language therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient group therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Opioid treatment services
Covered
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 0% or 14% coinsurance per item
Out-of-network: 14% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 0% or 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-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
Generic drugs :
25%
Brand-name drugs :
25%
Generic drugs :
$0 copay
Brand-name drugs :
$0 copay
Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier
Part B Drugs
Chemotherapy drugs
In-network: 0% or 0-20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
Other Part B drugs
In-network: $0 copay or 0-20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
Extra Benefits
Hearing
Hearing exam
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
In this article we rank Ohio Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.
The Medicare landscape in Ohio is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in Ohio.