2019 HumanaChoice H5216-111 (PPO) H5216-111-000 in IN from Humana | HealthPocket

HumanaChoice H5216-111 (PPO)

$15/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5216-111-000
Plan Year2019
CMS Rating
Plan TypePPO
Annual Deductible$100.00
Out-of-Pocket Maximum4500

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2020. see plan

Why We Like This Plan
  • has both Health and Drug Coverage

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$15.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network
$4,500 In-network
Optional Supplemental BenefitsYes

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$360 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-Network:50% per stay
Outpatient hospital coverageIn-Network:$250 per visit
Out-of-Network:50% per visit
Doctor visitsPrimary:
In-Network:$10 per visit
Out-of-Network:50% per visit
Specialist:
In-Network:$45 per visit
Out-of-Network:50% per visit
Preventive careIn-Network:$0 copay
Out-of-Network:$0 or 50%
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$10-45 or 50% per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:$0-105
Out-of-Network:50%
Lab services:
In-Network:$0-35
Out-of-Network:50%
Diagnostic radiology services (e.g., MRI):
In-Network:$45-250
Out-of-Network:50%
Outpatient x-rays:
In-Network:$10-95
Out-of-Network:50%
Mental health servicesInpatient hospital - psychiatric:
In-Network:$360 per day for days 1 through 4
$0 per day for days 5 through 90
Out-of-Network:50% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:$40
Out-of-Network:50%
Outpatient individual therapy visit with a psychiatrist:
In-Network:$40
Out-of-Network:50%
Outpatient group therapy visit:
In-Network:$40
Out-of-Network:50%
Outpatient individual therapy visit:
In-Network:$40
Out-of-Network:50%
Skilled Nursing FacilityIn-Network:$0 per day for days 1 through 20
$172 per day for days 21 through 100
Out-of-Network:50% per stay
Rehabilitation servicesOccupational therapy visit:
In-Network:$10-40
Out-of-Network:50%
Physical therapy and speech and language therapy visit:
In-Network:$10-40
Out-of-Network:50%
Ground ambulanceIn-Network:$265
Out-of-Network:$265
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:$45
Out-of-Network:50%
Routine foot care:Not covered
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:50% per item
Diabetes supplies:
In-Network:$0 or 10-20% per item
Out-of-Network:50% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:20%
Out-of-Network:20-50%
Other Part B drugs:
In-Network:20%
Out-of-Network:20-50%

Benefits Services

Hearing
Hearing examIn-Network: $45
Out-of-Network: 50%
Fitting/evaluationIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Hearing aidsIn-Network: $699-999
Out-of-Network: $699-999
There may be limits on how much the plan will provide.
Preventive Dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-ray(s)Not covered
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye examIn-Network: $0 copay
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 HumanaChoice H5216-111 (PPO)

StateIndiana
CountyMarion

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$2 copay$10 copay$2 copay
Tier 2: Non-Preferred Generic$8 copay$20 copay$8 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 Tier31% coinsurance31% coinsurance31% coinsurance
Tier 6: Select Care Drugs

90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$6 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$24 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
Tier 6: Select Care Drugs

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
Statin Use in Persons with Diabetes

Physicians that accept HumanaChoice H5216-111 (PPO) for Indiana

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Jane, Wilson
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Carol, Johnson
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Kevin, Julian
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Dakshina, Murthy
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Patricia, Burton
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Rachael, Bowles
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David, Clements
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Whitney, Blakley
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Kristin, Hine
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Todd, Capes
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Jayender, Chintaparthi
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Muhammad, Malik
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Christopher, Healy
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Emily, Keller
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Bryan, Benedict
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Abboud, Kawak
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Paola, Rosa
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Haris, Siraj
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Ryan, Alexander
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Jane Wilson, MD
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  • Phone Number
    (317) 780-4080
  • Office Locations
    5550 S East St
    Indianapolis, IN 46227
5550 S East St Indianapolis IN, 46227
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COST:from $0CMS Rating:Not Rated
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Reid Health Alliance Medicare HMO (HMO)
COST:from $0CMS Rating:
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IU Health Plans Medicare Select (HMO)
COST:from $0CMS Rating:
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HumanaChoice R0865-001 (Regional PPO)
COST:from $0CMS Rating:
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Allwell Medicare (HMO)
COST:from $0CMS Rating:Not Rated
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Medicare Plans Found

 

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family 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. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).