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: | BA-H5216 |
| 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 Preferred |
Copay Nonpreferred |
|---|---|---|
| 1 | $0 | $10 |
| 2 | $17 | $20 |
| 3 | $47 | $47 |
| 4 | $100 | $100 |
| 5 | 25% | 25% |
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.
