2022 HumanaChoice H5216-077 (PPO)


HumanaChoice H5216-077 (PPO) H5216-077 is a 2022 Medicare Advantage Plan or Part-C by Humana available to residents in Colorado and New Mexico. This plan does not provide additional prescription drug (Part-D) coverage. The HumanaChoice H5216-077 (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,000 out-of-pocket. This can be a extremely nice safety net.

HumanaChoice H5216-077 (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 H5216-077 (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 you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.




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2022 Humana Medicare Advantage Plan Costs

Name:
HumanaChoice H5216-077 (PPO)
Plan ID:
H5216-077
Provider:Humana
Year:2022
Type: Local PPO *
Monthly Premium C+D: $0
Part C Premium:
MOOP: $4,000
Similar Plan: H5216-078




2021 HumanaChoice H5216-077 (PPO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


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



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $30-250 copay
Diagnostic radiology services (e.g., MRI) 30% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0 copay or 30% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0-50 copay
Lab services $0 copay
Lab services $0 copay (Out-of-Network)
Outpatient x-rays 30% coinsurance (Out-of-Network)
Outpatient x-rays $0-50 copay



Doctor Visits


Primary 30% coinsurance per visit (Out-of-Network)
Primary $0 copay
Specialist $30 copay per visit
Specialist 30% coinsurance per visit (Out-of-Network)



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $0-40 copay or 30% coinsurance per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment 30% coinsurance (Out-of-Network)
Foot exams and treatment $30 copay
Routine foot care 30% coinsurance (Out-of-Network)
Routine foot care $0 copay



Ground Ambulance


$265 copay (Out-of-Network)
$265 copay



Hearing


Fitting/evaluation $0 copay
Fitting/evaluation $0 copay (Out-of-Network)
Hearing aids $699-999 copay
Hearing aids $699-999 copay (Out-of-Network)
Hearing exam $30 copay
Hearing exam 30% coinsurance (Out-of-Network)



Inpatient Hospital Coverage


$275 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
$300 per day for days 1 through 5
$0 per day for days 6 through 90 (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies $0 copay or 20% coinsurance per item (Out-of-Network)
Diabetes supplies $0 copay or 10-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) 18% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Chemotherapy 20-30% coinsurance (Out-of-Network)
Other Part B drugs 20-30% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $300 per day for days 1 through 5
$0 per day for days 6 through 90 (Out-of-Network)
Inpatient hospital - psychiatric $275 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit 30% coinsurance (Out-of-Network)
Outpatient group therapy visit $20 copay
Outpatient group therapy visit with a psychiatrist 30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $20 copay
Outpatient individual therapy visit $20 copay
Outpatient individual therapy visit 30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist 30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $20 copay



MOOP


$6,700 In and Out-of-network
$4,000 In-network



Option


No



Optional supplemental benefits


Yes



Outpatient Hospital Coverage


30% coinsurance per visit (Out-of-Network)
$20-250 copay per visit



Package #1


Deductible
Monthly Premium $27.20



Package #2


Deductible
Monthly Premium $37.40



Preventive Care


$0 copay or 30-50% coinsurance (Out-of-Network)
$0 copay



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit $20 copay
Occupational therapy visit 30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit $20 copay
Physical therapy and speech and language therapy visit 30% coinsurance (Out-of-Network)



Skilled Nursing Facility


$0 per day for days 1 through 20
$172 per day for days 21 through 60
$0 per day for days 61 through 100
30% per stay (Out-of-Network)



Transportation


$0 copay
50% coinsurance (Out-of-Network)



Vision


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



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for HumanaChoice H5216-077 (PPO) H5216



2021 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
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
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
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in HumanaChoice H5216-077 (PPO) Plans Performance

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


Health Plan Customer Service Rating for HumanaChoice H5216-077 (PPO)

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


HumanaChoice H5216-077 (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


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



Ready to Enroll?

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1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST




Coverage Area for HumanaChoice H5216-077 (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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