HumanaChoice H5216-056 (PPO)

Medicare Advantage Plan for Alabama

select spinner
PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5216-56-0
CMS Rating1
Plan TypePPO
Annual Deductible$250.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • was the best selling plan in Chambers in 2018

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$10,000 In and Out-of-network $6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$500 annual deductible
Monthly Drug Plan Premium
$26.90
Monthly Health Plan Premium
$18.10

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$325 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Out-of-Network:
30% per stay
Outpatient hospital coverage
In-Network:
$325 per visit. Out-of-Network:
30% per visit
Doctor visits
Primary:In-Network:
$15 per visit. Out-of-Network:
30% per visit
Specialist:In-Network:
$50 per visit. Out-of-Network:
30% per visit
Preventive care
In-Network:
$0 copay. Out-of-Network:
$0 or 30%
Emergency care/Urgent care
Emergency:$80 per visit (always covered)
Urgent care:$15-50 or 30% per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:In-Network:
$0-100Out-of-Network:
30%
Lab services:In-Network:
$0-50Out-of-Network:
30%
Diagnostic radiology services (e.g., MRI):In-Network:
$50-325Out-of-Network:
30%
Outpatient x-rays:In-Network:
$15-100Out-of-Network:
30%
Mental health services
In-Network:
$325 for days 1 through 4
$0 for days 5 through 90
Out-of-Network:
30% per stay
Outpatient group therapy visit with a psychiatrist:In-Network:
$40Out-of-Network:
30%
Outpatient individual therapy visit with a psychiatrist:In-Network:
$40Out-of-Network:
30%
Outpatient group therapy visit:In-Network:
$40Out-of-Network:
30%
Outpatient individual therapy visit:In-Network:
$40Out-of-Network:
30%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$167 for days 21 through 100
Out-of-Network:
30% per stay
Rehabilitation services
Occupational therapy visit:In-Network:
$15-40Out-of-Network:
30%
Physical therapy and speech and language therapy visit:In-Network:
$15-40Out-of-Network:
30%
Ambulance
In-Network:
$265 or 20%Out-of-Network:
$265 or 20%
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:In-Network:
$50Out-of-Network:
30%
Routine foot care:Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):In-Network:
20% per item. Out-of-Network:
25% per item
Prosthetics (e.g., braces, artificial limbs):In-Network:
20% per item. Out-of-Network:
25% per item
Diabetes supplies:In-Network:
$0 or 10-20% per item. Out-of-Network:
25% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:In-Network:
20%Out-of-Network:
30%
Other Part B drugs:In-Network:
20%Out-of-Network:
30%

Coverage Area for HumanaChoice H5216-056 (PPO)

StateAlabama
CountyJefferson

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$4 copay$10 copay$4 copay
Tier 2: Non-Preferred Generic$12 copay$20 copay$12 copay
Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Brand Name$100 copay$100 copay$100 copay
Tier 5: Specialty Tier28% coinsurance28% coinsurance28% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$12 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$36 copay$60 copay$0 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$131 copay
Tier 4: Non-Preferred Brand Name$300 copay$300 copay$290 copay
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept HumanaChoice H5216-056 (PPO) for Alabama

/
CUSTIS, JAMES
9772 PARKWAY E
BIRMINGHAM, AL 35215
SIMS, MARION
2152 OLD SPRINGVILLE ROAD
BIRMINGHAM, AL 35215
PIKE, BOB
9772 PARKWAY E
BIRMINGHAM, AL 35215
GONZALEZ, ENGLISH
2152 OLD SPRINGVILLE ROAD
BIRMINGHAM, AL 35215
GOTFRYD, MARK
1703 CENTER POINT PKWY
BIRMINGHAM, AL 35215
OWENS, KIMBERLY
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
KING, DUANE
1160 HUFFMAN ROAD
BIRMINGHAM, AL 35215
GRAY, GARY
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
TOBE-DONOHUE, COLLEEN
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
MOREHEAD, MARTHA
2152 OLD SPRINGVILLE ROAD
BIRMINGHAM, AL 35215
SULLIVAN, JAMES
1160 HUFFMAN RD
BIRMINGHAM, AL 35215
PETERS, DEBORAH
9772 PARKWAY E
BIRMINGHAM, AL 35215
GIAMMANCO, NATALIE
1985 AL HIGHWAY 157
CULLMAN, AL 35058
MOORE, KATHERINE
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
POWELL, MICHAEL
9772 PARKWAY E
BIRMINGHAM, AL 35215
ZAHARIAS, NERRIN
52 MEDICAL PARK DR E
BIRMINGHAM, AL 35235
GILMER, MARY
1801 GADSDEN HWY
BIRMINGHAM, AL 35235
DAVIS, DELINDA
3729 MARY TAYLOR RD
BIRMINGHAM, AL 35235
Details
JAMES CUSTIS, MD
Phone Number
(205) 833-6888
Office Locations
9772 PARKWAY E
BIRMINGHAM, AL 35215
9772 PARKWAY E BIRMINGHAM AL, 35215

Similar Plans

PremiumPlan NameCMS Rating
from $0
VIVA Medicare Me (HMO)
Details
from $20
SilverScript Choice (PDP)
Details
from $0
Aetna Medicare Liberty Plan (PPO)
Details
from $0
Humana Gold Plus H5619-088 (HMO)
Details
from $12
EnvisionRxPlus (PDP)
Details

Related Articles

Related Searches

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

{}