2020 HumanaChoice SNP-DE H5216-205 (PPO D-SNP) BA-H5216

HumanaChoice SNP-DE H5216-205 (PPO D-SNP) By Humana

HumanaChoice SNP-DE H5216-205 (PPO D-SNP) is a 2020 Medicare Advantage Special Needs Plan plan by Humana. This plan from Humana works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up 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. All Medicare SNPs also provide Medicare additional Part-D drug coverage. HumanaChoice SNP-DE H5216-205 (PPO D-SNP) BA-H5216 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.

2020 Medicare Special Needs Plan Details

Plan Name:
HumanaChoice SNP-DE H5216-205 (PPO D-SNP)
Plan ID:
Special Needs Type: Dual-Eligible
Provider: Humana
Plan Year:2020
Plan Type: Local PPO
Monthly Premium C+D: $25.00

The HumanaChoice SNP-DE H5216-205 (PPO D-SNP) BA-H5216 is available to residents in Georgia, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. HumanaChoice SNP-DE H5216-205 (PPO D-SNP) 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.

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

The HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan has a monthly drug premium of $25.00 and a $435.00 drug deductible. This Humana plan offers a $25.00 Part D Basic Premium that is 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 $25.00. 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 SNP-DE H5216-205 (PPO D-SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.20 for 75% low income subsidy $12.50 for 50% and $18.70 for 25%.

Part C Premium: $0.00
Part D (Drug) Premium: $25.00
Part D Supplemental Premium $0.00
Total Part D Premium: $25.00
Drug Deductible: $435.00
Tiers with No Deductible: 1
Benchmark: below the regional benchmark
Type of Medicare Health Plan: Basic Alternative
Drug Benefit Type: Basic
Full LIS Premium: $0.00
75% LIS Premium: $6.20
50% LIS Premium: $12.50
25% LIS Premium: $18.70
Gap Coverage: No

Gap Coverage

In 2020 once you and your plan provider have spent $4020 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 25% on generic drugs unless your plan offers additional coverage. This Humana plan does not offer additional coverage through the gap.

Humana Drug Coverage and Formulary

A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 HumanaChoice SNP-DE H5216-205 (PPO D-SNP) H5216-205 Formulary here.

Drug Tier Copay
1 $0 $10
2 $17 $20
3 $47 $47
4 $100 $100
5 25% 25%
*Initial Coverage Phase and 30 day supply

See the 2020 Humana Formulary

Ratings for HumanaChoice SNP-DE H5216-205 (PPO D-SNP) BA

2019 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
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 SNP-DE H5216-205 (PPO D-SNP) Plans Performance

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

Health Plan Customer Service Rating for HumanaChoice SNP-DE H5216-205 (PPO D-SNP)

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

HumanaChoice SNP-DE H5216-205 (PPO D-SNP) 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 SNP-DE H5216-205 (PPO D-SNP)

Source: CMS.

Plans as of September 4, 2019.

Star Rating as of October 11, 2019.

Plan Services are 2019 information as reference. 2020 information will be added when released.

Notes: Data are subject to change. All contracts for 2020 have not been finalized. For 2020, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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