HumanaChoice H5216-152 (PPO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Humana
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 4.0
out of 5 stars

State: Virginia

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

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

 

$0
$0
$0
$0
$3,400 In and Out-of-network
$3,400 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $10 per visit
Out-of-network: $10-40 per visit
In-network: $35 per visit
Out-of-network: $35 per visit

Tests, labs, & imaging

In-network: $0-85
Out-of-network: $0-85
In-network: $0-50
Out-of-network: $0-85
In-network: $35-275
Out-of-network: $35-300
In-network: $10-95
Out-of-network: $10-95
$120 per visit (always covered)
$10-35 per visit (always covered)

Hospital Services

In-network: $500 per stay
Out-of-network: $500 per stay
In-network: $35-300 per visit
Out-of-network: $35-300 per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100

Preventive services

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

Ambulance

In-network: $270
Out-of-network: $270

Therapy services

In-network: $10-40
Out-of-network: $10-40
In-network: $10-40
Out-of-network: $10-40

Mental health services

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

Opioid treatment services

Covered

Other services

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

Prescription Drug Benefits

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

Part B Drugs

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

Extra Benefits

Hearing

In-network: $35
Out-of-network: $35
In-network: $0 copay
Out-of-network: $0 copay
In-network: $699-999
Out-of-network: $699-999

Preventive Dental

In-network: $0 copay
Out-of-network: 50%
In-network: $0 copay
Out-of-network: 50%
Not covered
In-network: $0 copay
Out-of-network: 50%

Comprehensive dental

Not covered
Not covered
In-network: 50%
Out-of-network: 55%
Not covered
Not covered
In-network: 50%
Out-of-network: 55%
Not covered

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
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
 4
 4
 3
 4
 5
 4

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