2019 Humana Value Plus H5216-197 (PPO) H5216-197-0 in AZ from Humana | HealthPocket

Humana Value Plus H5216-197 (PPO)

$21/mo

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Zip Code85364
Applicant3/24/1984 Male
Coverage Start3/25/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5216-197-0
Plan Year2019
CMS Rating
Plan TypePPO
Annual Deductible$415.00

What To Know About This Plan
  • This plan has health and drug coverage

Why We Like This Plan
  • has both Health and Drug Coverage
  • has a copay of $1 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$21.30
Health Plan Deductible$185 per year for some in-network and out-of-network services.
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network
$6,700 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$1,750 per stay
Out-of-Network:$1,750 per stay
Outpatient hospital coverageIn-Network:20% per visit
Out-of-Network:$0 or 20% per visit
Doctor visitsPrimary:
In-Network:$0 copay
Out-of-Network:$0 copay
Specialist:
In-Network:20% per visit
Out-of-Network:20% per visit
Preventive careIn-Network:$0 copay
Out-of-Network:$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$0 or 20% per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:$0 or 20%
Out-of-Network:$0 or 20%
Lab services:
In-Network:$0 or 20%
Out-of-Network:$0 or 20%
Diagnostic radiology services (e.g., MRI):
In-Network:$0 or 20%
Out-of-Network:$0 or 20%
Outpatient x-rays:
In-Network:$0 or 20%
Out-of-Network:$0 or 20%
Mental health servicesInpatient hospital - psychiatric:
In-Network:$1,660 per stay
Out-of-Network:$1,660 per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:20%
Out-of-Network:20%
Outpatient individual therapy visit with a psychiatrist:
In-Network:20%
Out-of-Network:20%
Outpatient group therapy visit:
In-Network:20%
Out-of-Network:20%
Outpatient individual therapy visit:
In-Network:20%
Out-of-Network:20%
Skilled Nursing FacilityIn-Network:$0 per day for days 1 through 20
$172 per day for days 21 through 100
Out-of-Network:$0 per day for days 1 through 20
$172 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:
In-Network:20%
Out-of-Network:20%
Physical therapy and speech and language therapy visit:
In-Network:20%
Out-of-Network:20%
Ground ambulanceIn-Network:20%
Out-of-Network:20%
TransportationIn-Network:$0 copay
Out-of-Network:50%There may be limits on how much the plan will provide.
Foot care (podiatry services)Foot exams and treatment:
In-Network:20%
Out-of-Network:20%
Routine foot care:
In-Network:$0
Out-of-Network:$0 copay. There may be limits on how much the plan will provide.
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:20% per item
Out-of-Network:20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:20% per item
Out-of-Network:20% per item
Diabetes supplies:
In-Network:$0 or 20% per item
Out-of-Network:$0 or 20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:20%
Out-of-Network:$0 or 20%
Other Part B drugs:
In-Network:$0 or 20%
Out-of-Network:$0 or 20%

Benefits Services

Hearing
Hearing examIn-Network: 20%
Out-of-Network: 20%
Fitting/evaluationIn-Network: $0
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Hearing aidsIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Preventive Dental
Oral examIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
CleaningIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Fluoride treatmentNot covered
Dental x-ray(s)In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesIn-Network: $0
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsIn-Network: $0
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Prosthodontics, other oral/maxillofacial surgery, other servicesIn-Network: $0
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Vision
Routine eye examIn-Network: $0
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for Humana Value Plus H5216-197 (PPO)

StateArizona
CountyYuma

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$1 copay$10 copay$1 copay
Tier 2: Non-Preferred Generic$20 copay$20 copay$20 copay
Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Brand Name50% coinsurance50% coinsurance50% coinsurance
Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$3 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$60 copay$60 copay$0 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$131 copay
Tier 4: Non-Preferred Brand Name50% coinsurance50% coinsurance50% coinsurance
Tier 5: Specialty Tier

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 managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot 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

Physicians that accept Humana Value Plus H5216-197 (PPO) for Arizona

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Patel, Kita
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Plante, Mark
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Luthra, Chaman
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Karmakar, Kanka
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Khandelwal, Keerti
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Tontz, William
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Njoroge, Stephen
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Larson, Paul
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Deokule, Sunil
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Sutphin, Daniel
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Haddad, Nader
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Sweidan, Dania
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Carter, Henri
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Zoellner, Gary
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Kinkade, Amy
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Chandra, Abhinav
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Walks, Norma
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Diaz, Kristina
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Miller, Seth
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Mann, Manith
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Gregg, James
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Duque, Wilbur Don
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Sharif, Omar
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Jensen, Candice
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Kita Patel, M.D.
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  • Phone Number
    (602) 273-6770
  • Office Locations
    2400 S Ave A
    Yuma, AZ 85364
2400 S Ave A Yuma AZ, 85364

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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.

Medicare Plans Found

 

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.