HumanaChoice H5216-093 (PPO)

Medicare Advantage Plan for Arkansas

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5216-93-0
CMS Rating1
Plan TypePPO
Annual Deductible$150.00

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 4th best selling plan in Crittenden 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
$750 annual deductible
Monthly Drug Plan Premium
$39.70
Monthly Health Plan Premium
$19.30

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$285 for days 1 through 6
$0 for days 7 through 90
$0 for days 91 and beyond
Out-of-Network:
30% per stay
Outpatient hospital coverage
In-Network:
$275 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:
$45 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:
$15-45 or 30% per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$0-90
Out-of-Network:
30%
Lab services:
In-Network:
$0-45
Out-of-Network:
30%
Diagnostic radiology services (e.g., MRI):
In-Network:
$45-275
Out-of-Network:
30%
Outpatient x-rays:
In-Network:
$15-90
Out-of-Network:
30%
Mental health services
In-Network:
$285 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
30% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
30%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
30%
Outpatient group therapy visit:
In-Network:
$40
Out-of-Network:
30%
Outpatient individual therapy visit:
In-Network:
$40
Out-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
Out-of-Network:
30%
Physical therapy and speech and language therapy visit:
In-Network:
$15
Out-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:
$45
Out-of-Network:
30%
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
19% per item
Out-of-Network:
20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
30% per item
Diabetes supplies:
In-Network:
$0 or 10-20% per item
Out-of-Network:
20% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
20-30%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
20-30%

Coverage Area for HumanaChoice H5216-093 (PPO)

StateArkansas
CountyPulaski

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$5 copay$10 copay$5 copay
Tier 2: Non-Preferred Generic$15 copay$20 copay$15 copay
Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Brand Name$97 copay$100 copay$97 copay
Tier 5: Specialty Tier30% coinsurance30% coinsurance30% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$15 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$45 copay$60 copay$0 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$131 copay
Tier 4: Non-Preferred Brand Name$291 copay$300 copay$281 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 H5216-093 (PPO) for Arkansas

/
JOHN, CHRISTOPHER
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
CARUTHERS, CAROL
6924 GEYER SPRINGS RD
LITTLE ROCK, AR 72209
CARNEY, JOHN
11321 I-30
LITTLE ROCK, AR 72209
CROWELL, BERNARD
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
BADHWAR, ANIL
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
SNYDER, STEPHEN
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
CROWELL, KAREN
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
ABDELAL, AHMED
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
BUDHRAJA, MADHU
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
WOLVERTON, JOHN
6924 GEYER SPRINGS
LITTLE ROCK, AR 72209
KUPERMAN, IRVING
5300 MABELVALE PIKE
LITTLE ROCK, AR 72209
JOSEPH, WILLIAM
4202 S UNIVERSITY AVE
LITTLE ROCK, AR 72204
CASPER, ROBERT
4202 S UNIVERSITY AVE
LITTLE ROCK, AR 72204
MCCARTHY, KATHRYN
800 FAIR PARK BLVD
LITTLE ROCK, AR 72204
VELEZ, LOUIS
4202 S UNIVERSITY AVE
LITTLE ROCK, AR 72204
SEALE, JARED
800 FAIR PARK BLVD
LITTLE ROCK, AR 72204
RODGERS, CHARLES
4202 S UNIVERSITY AVE
LITTLE ROCK, AR 72204
JOHNSON, CARL
5320 W 12TH ST
LITTLE ROCK, AR 72204
RILEY, WILLIAM
4202 S UNIVERSITY AVE
LITTLE ROCK, AR 72204
HARGROVE, JOE
5315 W 12TH ST
LITTLE ROCK, AR 72204
FEURTADO, MARGARET
4202 S UNIVERSITY AVE
LITTLE ROCK, AR 72204
LEWIS, DEREK
6209 W 12TH ST
LITTLE ROCK, AR 72204
COOPER, KEITH
4202 S UNIVERSITY AVE
LITTLE ROCK, AR 72204
CALDERON, VINCENT
4202 S UNIVERSITY AVE
LITTLE ROCK, AR 72204
Details
CHRISTOPHER JOHN, MD
Phone Number
(501) 407-0200
Office Locations
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
11321 INTERSTATE 30 LITTLE ROCK AR, 72209

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