HumanaChoice H5216-266 (PPO)
Virginia Medicare Advantage Plan (2024 Plan)
Monthly Premium
Additional Coverage
Overall Government Star Rating
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Plan Overview
HumanaChoice H5216-266 (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Virginia 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 H5216-266 (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,950 In and Out-of-network $5,400 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 H5216-266 (PPO) are defined below.
Additional Benefits and Coverage
HumanaChoice H5216-266 (PPO) 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 H5216-266 (PPO) includes coverage for hearing, vision.
Medicare Advantage health plans can offer even more additional benefits. HumanaChoice H5216-266 (PPO) includes coverage for the following additional benefits:
Other benefits
Comparing the Quality Score of HumanaChoice H5216-266 (PPO) to Other Plans in Virginia
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 H5216-266 (PPO) received an overall government quality rating of 4.5 stars out of 5 stars.
HumanaChoice H5216-266 (PPO) performed better than Virginia’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 H5216-266 (PPO) received 4.5 stars for its health plan quality score which is better than the Virginia State average health plan quality score of 3.9 stars.
HumanaChoice H5216-266 (PPO) received 4 stars for its drug plan quality score which is better than the Virginia State average drug plan quality score of 3.8 stars.
Plan Benefits and Coverage Details
$5,400 In-network
Medical Benefits
Doctor Services
Out-of-network: 40% coinsurance per visit
Out-of-network: 40% coinsurance per visit
Tests, labs, & imaging
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Hospital Services
$0 per day for days 6 through 90
$0 per day for days 90 and beyond
Out-of-network: 40% per stay
Out-of-network: 40% coinsurance per visit
Skilled nursing facility
$203 per day for days 21 through 100
Out-of-network: 40% per stay
Preventive services
Out-of-network: $0 copay or 40% coinsurance
Ambulance
Out-of-network: $300 copay
Therapy services
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Mental health services
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Opioid treatment services
Other services
Out-of-network: 40% coinsurance per item
Out-of-network: 40% coinsurance per item
Out-of-network: 40% 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 | $0.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
| Generic | $0.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | $100.00 copay | ||
| Specialty Tier | 33% |
Part B Drugs
Out-of-network: 20-40% coinsurance
Out-of-network: 20-40% coinsurance
Extra Benefits
Hearing
Out-of-network: 40% coinsurance
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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