Plan Details
Costs and Other Important Information
Benefits
20% per visit
Specialist:
20% per visit
20%
Urgent care:
20%
20%
Lab services:
20%
Diagnostic radiology services (e.g., MRI):
20%
Outpatient x-rays:
20%
Outpatient group therapy visit with a psychiatrist:
20%
Outpatient individual therapy visit with a psychiatrist:
20%
Outpatient group therapy visit:
20%
Outpatient individual therapy visit:
20%
20%
Physical therapy and speech and language therapy visit:
20%
20%
Routine foot care:
20%
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
20% per item
20%
Other Part B drugs:
20%
Coverage Area for Humana Enhanced (PDP)
State | Arizona |
---|---|
County | Yuma |
Cost Sharing Information
All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit
30 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
---|---|---|---|
Tier 1: Preferred Generic | $3 copay | $7 copay | $3 copay |
Tier 2: Non-Preferred Generic | $7 copay | $12 copay | $7 copay |
Tier 3: Preferred Brand Name | $42 copay | $47 copay | $42 copay |
Tier 4: Non-Preferred Brand Name | 44% coinsurance | 50% coinsurance | 44% coinsurance |
Tier 5: Specialty Tier | 33% coinsurance | 33% coinsurance | 33% coinsurance |
90 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
---|---|---|---|
Tier 1: Preferred Generic | $9 copay | $21 copay | $0 copay |
Tier 2: Non-Preferred Generic | $21 copay | $36 copay | $7 copay |
Tier 3: Preferred Brand Name | $126 copay | $141 copay | $116 copay |
Tier 4: Non-Preferred Brand Name | 44% coinsurance | 50% coinsurance | 44% coinsurance |
Tier 5: Specialty Tier |