HumanaChoice H6609-120 (PPO) By Humana Insurance Company
HumanaChoice H6609-120 (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 H6609-120 (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 H6609-120 (PPO) |
|---|---|
| Plan ID: | H6609-120 |
| Provider: | Humana Insurance Company |
| Plan Year: | 2015 |
| Plan Type: | Local PPO |
| Monthly Premium C+D: | $42.00 |
| MOOP: | $5,900 |
Coverage Area for HumanaChoice H6609-120 (PPO)
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The HumanaChoice H6609-120 (PPO) H6609-120 is available to residents in Alabama, Georgia, South Carolina, and has a in-network Maximum Out-of-Pocket limit of $5,900 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in HumanaChoice H6609-120 (PPO) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $5,900 This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.
HumanaChoice H6609-120 (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 H6609-120 (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 H6609-120 (PPO) Plans Performance
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for HumanaChoice H6609-120 (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 H6609-120 (PPO) Drug Plan Customer Service ratings
| Total Rating | ||
|---|---|---|
| Appeals Auto Forward | ||
| Appeals Upheld |
Part-C Premium
Humana Insurance Company plan charges a $8.90 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 H6609-120 (PPO) plan has a monthly drug premium of $33.10 and a $320.00 drug deductible. This Humana Insurance Company plan offers a $33.10 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 $0.00 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 $33.10. 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 H6609-120 (PPO) medicare insurance plan offers a $5.40 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $12.30 for 75% low income subsidy $19.20 for 50% and $26.20 for 25%.
| Part C Premium: | $8.90 |
|---|---|
| Part D (Drug) Premium: | $33.10 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $33.10 |
| Drug Deductible: | $320.00 |
| 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: | $5.40 |
| 75% LIS Premium: | $12.30 |
| 50% LIS Premium: | $19.20 |
| 25% LIS Premium: | $26.20 |
| 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.