2023 Humana Honor (PPO)

Humana Honor (PPO) H5216-059 is a 2023 Medicare Advantage Plan or Part-C by Humana available to residents in Maine and New Hampshire. This plan does not provide additional prescription drug (Part-D) coverage. Humana Humana Honor (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,500 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $4,500 out-of-pocket. This can be an extremely nice safety net.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Honor (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 2023 Medicare Advantage Plan 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 if you sign up for Medicare Advantage in Maine or Medicare Advantage in New Hampshire.




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2023 Humana Medicare Advantage Plan Overview

Name:Humana Honor (PPO)
Plan ID:H5216 059 0
Provider:Humana
Year:2023
Type:Local PPO *
Combined Premium (C+D):$0/mo
MOOP:$4,500/yr
Similar Plan: H5216-062




What type of plan is Humana Honor (PPO)

Humana Honor (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.

How much does Humana Honor (PPO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Humana charges a $0 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.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Humana Honor (PPO) by Humana MOOP is $4,500. Once you spend $4,500 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.





Summary of Benefits

*2021 data this will be updated with 2023 data when available.

The benefit information provided is a summary of what Humana Honor (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Humana helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.




Additional Benefits


No



Comprehensive Dental


Diagnostic services Not covered
Endodontics Not covered
Extractions 50% coinsurance
Extractions 55% coinsurance (Out-of-Network)
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) $0-350 copay
Diagnostic radiology services (e.g., MRI) 30% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0 copay or 20-30% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0-90 copay
Lab services $0-40 copay
Lab services 20-30% coinsurance (Out-of-Network)
Outpatient x-rays $0-90 copay
Outpatient x-rays 20-30% coinsurance (Out-of-Network)



Doctor Visits


Primary $0 copay
Primary 30% coinsurance per visit (Out-of-Network)
Specialist 30% coinsurance per visit (Out-of-Network)
Specialist $40 copay per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $0-40 copay or 20-30% coinsurance per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $40 copay
Foot exams and treatment 30% coinsurance (Out-of-Network)
Routine foot care Not covered



Ground Ambulance


$290 copay
$290 copay (Out-of-Network)



Hearing


Fitting/evaluation $0 copay (Out-of-Network)
Fitting/evaluation $0 copay
Hearing aids $199-499 copay (Out-of-Network)
Hearing aids $199-499 copay
Hearing exam $40 copay
Hearing exam 30% coinsurance (Out-of-Network)



Inpatient Hospital Coverage


$350 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
30% per stay (Out-of-Network)



Medical Equipment/Supplies


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



Medicare Part B Drugs


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



Mental Health Services


Inpatient hospital - psychiatric 30% per stay (Out-of-Network)
Inpatient hospital - psychiatric $324 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit $40 copay
Outpatient group therapy visit 30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient group therapy visit with a psychiatrist 30% coinsurance (Out-of-Network)
Outpatient individual therapy visit 30% coinsurance (Out-of-Network)
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit with a psychiatrist 30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay



MOOP


$10,000 In and Out-of-network
$4,500 In-network



Option


No



Optional supplemental benefits


Yes



Outpatient Hospital Coverage


$40-350 copay per visit
30% coinsurance per visit (Out-of-Network)



Package #1


Deductible
Monthly Premium $35.60



Package #2


Deductible
Monthly Premium $50.50



Preventive Care


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



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit 30% coinsurance (Out-of-Network)
Occupational therapy visit $40 copay
Physical therapy and speech and language therapy visit $40 copay
Physical therapy and speech and language therapy visit 30% coinsurance (Out-of-Network)



Skilled Nursing Facility


30% per stay (Out-of-Network)
$0 per day for days 1 through 20
$184 per day for days 21 through 100



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


Is Humana Honor (PPO) a good plan? Humana Honor (PPO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Humana Honor (PPO) performance among several different plans.

2022 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
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H5216-059 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 Plans Performance

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


Health Plan Customer Service Rating for Humana

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


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



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1-855-778-4180
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Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Humana Honor (PPO) requires you to live in that plan’s service area. The service area is listed below:



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How much does Humana Honor (PPO) cost?

Humana charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Humana Honor (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Humana Honor (PPO) by Humana MOOP is $4,500. Once you spend $4,500 you will pay nothing for Part A or Part B covered services.

What type of plan is Humana Honor (PPO)?

Humana Honor (PPO) is a Local PPO *. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.

Is Humana Honor (PPO) a good plan?

Humana Honor (PPO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, 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 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*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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