2015 HumanaChoice H6609-126 (PPO) H6609-126 By Humana Insurance Company

HumanaChoice H6609-126 (PPO) By Humana Insurance Company



HumanaChoice H6609-126 (PPO) is a 2015 Medicare Advantage ("Part C" or "MA Plan") plan by Humana Insurance Company. This plan from Humana Insurance Company works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for HumanaChoice H6609-126 (PPO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Humana Insurance Company and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



2015 Medicare Advantage Plan Details

Plan Name:
HumanaChoice H6609-126 (PPO)
Plan ID:
H6609-126
Provider: Humana Insurance Company
Plan Year:2015
Plan Type: Local PPO
Monthly Premium C+D: $58.00
MOOP: $6,700


COMPARE AND SAVE ON MEDICARE INSURANCE




Coverage Area for HumanaChoice H6609-126 (PPO)

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The HumanaChoice H6609-126 (PPO) H6609-126 is available to residents in Arkansas, Kansas, Missouri, Oklahoma, and has a in-network Maximum Out-of-Pocket limit of $6,700 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in HumanaChoice H6609-126 (PPO) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $6,700 This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.

HumanaChoice H6609-126 (PPO) is a Local PPO. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.





Ratings for HumanaChoice H6609-126 (PPO) H6609

2015 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in HumanaChoice H6609-126 (PPO) Plans Performance

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for HumanaChoice H6609-126 (PPO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancel Screening
Cardiovascular Screening
Diabetes Care
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Ratings For Managing Chronic And Long Term Care

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Diabetes Care - Cholesterol
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions


Ratings For Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
High Risk Medication
Diabetes Treatment
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


HumanaChoice H6609-126 (PPO) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld


Part-C Premium

Humana Insurance Company plan charges a $17.80 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



Part-D Deductible and Premium

The HumanaChoice H6609-126 (PPO) plan has a monthly drug premium of $36.60 and a $275.00 drug deductible. This Humana Insurance Company plan offers a $36.60 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $3.60 this Premium covers any enhanced plan benefits offered by Humana Insurance Company above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $40.20. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The HumanaChoice H6609-126 (PPO) medicare insurance plan offers a $11.70 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $18.80 for 75% low income subsidy $25.90 for 50% and $33.10 for 25%.



Part C Premium: $17.80
Part D (Drug) Premium: $36.60
Part D Supplemental Premium $3.60
Total Part D Premium: $40.20
Drug Deductible: $275.00
Tiers with No Deductible: 1
Benchmark: not below the regional benchmark
Type of Medicare Health Plan: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $11.70
75% LIS Premium: $18.80
50% LIS Premium: $25.90
25% LIS Premium: $33.10
Inital Coverage Limit:$2960
Gap Coverage: Yes


Gap Coverage

In 2015 once you and your plan provider have spent $2,960 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will still receive a 55% discount on brand-name drugs and a 35% discount on generic drugs. Once you reach the coverage gap you will pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. This Humana Insurance Company plan does offer additional coverage through the gap.





Source: CMS.

Plans as of September 2, 2014.

Star Rating as of Oct 3, 2014.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change. All contracts for 2015 have been finalized. For 2015, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit

Includes 2015 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.