HumanaChoice H5216-368 (PPO)

Health Insurance Company: Humana

Medicare Advantage Plan Details

Humana
$7 /mo
monthly premium
HumanaChoice H5216-368 (PPO)
Additional Coverage
Overall Star Rating (2024)
  • Rx
  • Vision
  • Hearing
4.5
out of 5 stars

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$6700
Rx Drug Coverage
Yes
Rx Deductible
$150
Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$40 copay per visit

Additional Benefits

Dental Coverage
No
Vision Coverage
Yes
Mental Health Coverage
Yes
Transportation for non-emergency
No
Fitness Benefits
Yes
Worldwide emergency
Yes
Telehealth
Yes
Part B Give Back
Yes

Doctor & Hospital Coverage

Primary Doctor Office Visit
In-network: $0 copay
Out-of-network: 40% coinsurance per visit
Specialist Office Visit
In-network: $40 copay per visit
Out-of-network: 40% coinsurance per visit
Periodic Exam Coverage
In-network: $0 copay
Out-of-network: $0 copay or 40% coinsurance

Emergency Room

$100 copay per visit (always covered)

Ambulance Coverage

In-network: $300 copay
Out-of-network: $300 copay

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $0-75 copay
Out-of-network: 40% coinsurance
Medicare-covered lab services: In-network: $0-40 copay
Out-of-network: 40% coinsurance
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $0-300 copay
Out-of-network: 40% coinsurance
Medicare-covered x-ray services: In-network: $0-125 copay
Out-of-network: 40% coinsurance

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $0-250 copay per visit
Out-of-network: 40% coinsurance per visit

Hospitalization Coverage

Inpatient hospital-acute:
In-network: $275 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 90 and beyond
Out-of-network: 40% per stay
Inpatient hospital psychiatric:
In-network: $260 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: 40% per stay

Rehabilitation Coverage

Occupational therapy services:
In-network: $20 copay
Out-of-network: 40% coinsurance
Physical therapy and speech and language therapy services:
In-network: $20 copay
Out-of-network: 40% coinsurance

Urgent Care Coverage

$40 copay per visit (always covered)

Skilled Nursing Facility (SNF)

In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Out-of-network: 40% per stay

Mental Health Coverage

Medicare-covered individual sessions: In-network: $40 copay
Out-of-network: 40% coinsurance
Medicare-covered group sessions: In-network: $40 copay
Out-of-network: 40% coinsurance

Dental, Vision, Hearing Benefits

Dental Services

Oral exams: In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning): In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays: In-network: $0 copay
Out-of-network: $0 copay

Vision Benefits

Eye exams:
Routine eye exams: In-network: $0 copay
Out-of-network: $0 copay
Eyewear:
Contact Lenses: In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses: In-network: $0 copay
Out-of-network: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: In-network: $40 copay
Out-of-network: 40% coinsurance
Hearing aids:
Hearing aids (all types): In-network: $399-699 copay
Out-of-network: 50% coinsurance

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$5.00 copay (30-day supply)
$15.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$97.00 copay (30-day supply)
$291.00 copay (90-day supply)

Tier 5: Specialty Tier

30% coinsurance (30-day supply)

Tier 1: Preferred Generic

$10.00 copay (30-day supply)
$30.00 copay (90-day supply)

Tier 2: Generic

$20.00 copay (30-day supply)
$60.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$100.00 copay (30-day supply)
$300.00 copay (90-day supply)

Tier 5: Specialty Tier

30% coinsurance (30-day supply)

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$5.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$131.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$97.00 copay (30-day supply)
$281.00 copay (90-day supply)

Tier 5: Specialty Tier

30% coinsurance (30-day supply)

More Additional Benefits

Annual physical exams
Yes
Chiropractic Coverage
No
Acupuncture
Yes
Massage Therapy
No
Health Education
No
Counseling Services
No
Support for Caregivers of Enrollees
No
Personal Emergency Response System (PERS)
No
In-home support services
No
Home and bathroom safety devices
No
Meals for short duration
Yes

Plan Links

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Where This Plan is Available

Additional Plan Info

Plan Year:
2024
Insurance Company Website:
Humana

Health Insurance Companies Offering Plans

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