2019 Humana Value Plus H5525-040 (PPO) H5525-040 By Humana

2019 Medicare Advantage Plan Services for
Humana Value Plus H5525-040 (PPO)


Humana Value Plus H5525-040 (PPO) H5525-040 is a 2019 Medicare Advantage or Medicare Part-C plan by Humana available to residents in Kentucky. This plan includes additional Medicare prescription drug (Part-D) coverage. The Humana Value Plus H5525-040 (PPO) has a monthly premium of $29.90 and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out of pocket. This can be a extremely nice safety net.

Humana Value Plus H5525-040 (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.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Value Plus H5525-040 (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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2019 Humana Medicare Advantage Plan Details

Name:
Humana Value Plus H5525-040 (PPO)
ID:
H5525-040
Provider:Humana
Year:2019
Type: Local PPO
Monthly Premium C+D: $29.90
Part C Premium:$0.00
MOOP: $6,700
Part D (Drug) Premium:$29.90
Part D Supplemental Premium$0.00
Total Part D Premium:$29.90
Drug Deductible:$260.00
Tiers with No Deductible:1
Gap Coverage:No
Initial Coverage Limit:$3820
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced






Part-C Premium

Humana plan charges a $0.00 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

Humana Value Plus H5525-040 (PPO) has a monthly drug premium of $29.90 and a $260.00 drug deductible. This Humana plan offers a $29.90 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 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 $29.90. 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 Humana Value Plus H5525-040 (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $7.50 for 75% low income subsidy $14.90 for 50% and $22.40 for 25%.



Full LIS Premium:$0.00
75% LIS Premium:$7.50
50% LIS Premium:$14.90
25% LIS Premium:$22.40


Gap Coverage

In 2019 once you and your plan provider have spent $3820 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for brand-name drugs and 37% on generic drugs unless your plan offers additional coverage. This Humana plan does not offer additional coverage through the gap.





Plan Services




Health plan deductible


Coming soon



Emergency care/Urgent care


Emergency $90 per visit (always covered)
Urgent care 20% per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures Out-of-Network 20%
Diagnostic tests and procedures In-Network $0 or 20%
Lab services Out-of-Network $0 or 20%
Lab services In-Network $0 or 20%
Diagnostic radiology services (e.g., MRI) Out-of-Network 20%
Diagnostic radiology services (e.g., MRI) In-Network 20%
Outpatient x-rays Out-of-Network 20%
Outpatient x-rays In-Network 20%



Hearing


Hearing exam Out-of-Network 20%
Hearing exam In-Network 20%
Fitting/evaluation Out-of-Network $0 copay
Fitting/evaluation In-Network $0
Hearing aids Out-of-Network $0 copay
Hearing aids In-Network $0 copay



Preventive dental


Oral exam Out-of-Network 50%
Oral exam In-Network $0 copay
Cleaning Out-of-Network 50%
Cleaning In-Network $0 copay
Fluoride treatment Not covered
Dental x-ray(s) Out-of-Network 50%
Dental x-ray(s) In-Network $0 copay



Comprehensive dental


Non-routine services Not covered
Diagnostic services Not covered
Restorative services Out-of-Network 55%
Restorative services In-Network 50%
Endodontics Not covered
Periodontics Not covered
Extractions Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered



Vision


Routine eye exam Out-of-Network $0 copay
Routine eye exam In-Network $0
Other Not covered
Contact lenses Out-of-Network $0 copay
Contact lenses In-Network $0 copay
Eyeglasses (frames and lenses) Out-of-Network $0 copay
Eyeglasses (frames and lenses) In-Network $0 copay
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric Out-of-Network $1,660 per stay
Inpatient hospital - psychiatric In-Network $1,660 per stay
Outpatient group therapy visit with a psychiatrist Out-of-Network 20%
Outpatient group therapy visit with a psychiatrist In-Network 20%
Outpatient individual therapy visit with a psychiatrist Out-of-Network 20%
Outpatient individual therapy visit with a psychiatrist In-Network 20%
Outpatient group therapy visit Out-of-Network 20%
Outpatient group therapy visit In-Network 20%
Outpatient individual therapy visit Out-of-Network 20%
Outpatient individual therapy visit In-Network 20%



Skilled Nursing Facility


Out-of-Network $0 per day for days 1 through 20
$172 per day for days 21 through 100
In-Network $0 per day for days 1 through 20
$172 per day for days 21 through 100



Rehabilitation services


Occupational therapy visit Out-of-Network 20%
Occupational therapy visit In-Network 20%
Physical therapy and speech and language therapy visit Out-of-Network 20%
Physical therapy and speech and language therapy visit In-Network 20%



Ground ambulance


Out-of-Network 20%
In-Network 20%



Other health plan deductibles?


In-Network No



Transportation


Out-of-Network 50%
In-Network $0 copay



Foot care (podiatry services)


Foot exams and treatment Out-of-Network 20%
Foot exams and treatment In-Network 20%
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 18% per item
Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 18% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Diabetes supplies Out-of-Network $0 or 20% per item
Diabetes supplies In-Network $0 or 20% per item



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy Out-of-Network $0 or 20%
Chemotherapy In-Network 20%
Other Part B drugs Out-of-Network $0 or 20%
Other Part B drugs In-Network $0 or 20%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$10,000 In and Out-of-network
$6,700 In-network



Optional supplemental benefits


No



Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?


In-Network No



Inpatient hospital coverage


Out-of-Network $1,860 per stay
In-Network $1,860 per stay



Outpatient hospital coverage


Out-of-Network 20% per visit
In-Network 20% per visit



Doctor visits


Primary Out-of-Network 20% per visit
Primary In-Network 20% per visit
Specialist Out-of-Network 20% per visit
Specialist In-Network 20% per visit



Preventive care


Out-of-Network $0 copay
In-Network $0 copay




Ratings for Humana Value Plus H5525-040 (PPO) H5525

2018 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


Staying Healthy, Screening, Testing, & Vaccines

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


Managing Chronic And Long Term Care for Older Adults

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
Controlling Blood Pressure
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Plan All-Cause Readmissions
Statin Therapy


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 Humana Value Plus H5525-040 (PPO) Plans Performance

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


Health Plan Customer Service Rating for Humana Value Plus H5525-040 (PPO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Humana Value Plus H5525-040 (PPO) Drug Plan Customer Service ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld


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


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
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area for Humana Value Plus H5525-040 (PPO)

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Source: CMS.
Data as of September 2, 2018.
Star Rating as of October 10, 2018.
For More Information on Ratings Please See the CMS Tech Notes.
Notes: Data are subject to change as contracts are finalized. For 2019, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2019 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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