2019 HumanaChoice H5216-157 (PPO) H5216-157 By Humana

2019 Medicare Advantage Plan Services for
HumanaChoice H5216-157 (PPO)


HumanaChoice H5216-157 (PPO) H5216-157 is a 2019 Medicare Advantage or Medicare Part-C plan by Humana available to residents in South Carolina Georgia. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The HumanaChoice H5216-157 (PPO) has a monthly premium of $- 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.

HumanaChoice H5216-157 (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 HumanaChoice H5216-157 (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:
HumanaChoice H5216-157 (PPO)
ID:
H5216-157
Provider:Humana
Year:2019
Type: Local PPO *
Monthly Premium C+D: $-
Part C Premium:
MOOP: $6,700






Plan Services




Health plan deductible


$0



Emergency care/Urgent care


Emergency $90 per visit (always covered)
Urgent care $10-45 or 30% per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures In-Network $0-95
Diagnostic tests and procedures Out-of-Network 30%
Lab services In-Network $0-45
Lab services Out-of-Network 30%
Diagnostic radiology services (e.g., MRI) In-Network $45-245
Diagnostic radiology services (e.g., MRI) Out-of-Network 30%
Outpatient x-rays In-Network $10-95
Outpatient x-rays Out-of-Network 30%



Hearing


Hearing exam In-Network $45
Hearing exam Out-of-Network 30%
Fitting/evaluation In-Network $0 copay
Fitting/evaluation Out-of-Network $0 copay
Hearing aids In-Network $399-699
Hearing aids Out-of-Network $399-699



Preventive dental


Oral exam In-Network $0 copay
Oral exam Out-of-Network $0 copay
Cleaning In-Network $0 copay
Cleaning Out-of-Network $0 copay
Fluoride treatment In-Network $0 copay
Fluoride treatment Out-of-Network $0 copay
Dental x-ray(s) In-Network $0 copay
Dental x-ray(s) Out-of-Network $0 copay



Comprehensive dental


Non-routine services In-Network $0 copay
Non-routine services Out-of-Network $0 copay
Diagnostic services Not covered
Restorative services In-Network $0 copay
Restorative services Out-of-Network $0 copay
Endodontics In-Network $0 copay
Endodontics Out-of-Network $0 copay
Periodontics In-Network $0 copay
Periodontics Out-of-Network $0 copay
Extractions In-Network $0 copay
Extractions Out-of-Network $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services In-Network $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services Out-of-Network $0 copay



Vision


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



Mental health services


Inpatient hospital - psychiatric In-Network $245 per day for days 1 through 6
$0 per day for days 7 through 90
Inpatient hospital - psychiatric Out-of-Network 30% per stay
Outpatient group therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit with a psychiatrist Out-of-Network 30%
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient individual therapy visit with a psychiatrist Out-of-Network 30%
Outpatient group therapy visit In-Network $40
Outpatient group therapy visit Out-of-Network 30%
Outpatient individual therapy visit In-Network $40
Outpatient individual therapy visit Out-of-Network 30%



Skilled Nursing Facility


In-Network $0 per day for days 1 through 20
$172 per day for days 21 through 100
Out-of-Network 30% per stay



Rehabilitation services


Occupational therapy visit In-Network $10-40
Occupational therapy visit Out-of-Network 30%
Physical therapy and speech and language therapy visit In-Network $10-40
Physical therapy and speech and language therapy visit Out-of-Network 30%



Ground ambulance


In-Network $265
Out-of-Network $265



Other health plan deductibles?


In-Network No



Transportation


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



Foot care (podiatry services)


Foot exams and treatment In-Network $45
Foot exams and treatment Out-of-Network 30%
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 30% per item
Diabetes supplies In-Network $0 or 10-20% per item
Diabetes supplies Out-of-Network 30% per item



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


Covered



Medicare Part B drugs


Chemotherapy In-Network 20%
Chemotherapy Out-of-Network 30%
Other Part B drugs In-Network 20%
Other Part B drugs Out-of-Network 30%



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


In-Network $245 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91
Out-of-Network 30% per stay



Outpatient hospital coverage


In-Network $245 per visit
Out-of-Network 30% per visit



Doctor visits


Primary In-Network $10 per visit
Primary Out-of-Network 30% per visit
Specialist In-Network $45 per visit
Specialist Out-of-Network 30% per visit



Preventive care


In-Network $0 copay
Out-of-Network $0 or 30%




Ratings for HumanaChoice H5216-157 (PPO) H5216

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 HumanaChoice H5216-157 (PPO) Plans Performance

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


Health Plan Customer Service Rating for HumanaChoice H5216-157 (PPO)

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


HumanaChoice H5216-157 (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 HumanaChoice H5216-157 (PPO)

(Click county to compare all available Advantage plans)



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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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