2020 Humana Value Plus H5216-199 (PPO) H5216-199-0 in NM from Humana | HealthPocket

Humana Value Plus H5216-199 (PPO)

$16/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5216-199-0
Plan Year2020
CMS Rating
Plan TypePPO
Annual Deductible$435.00
Out-of-Pocket Maximum6700

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

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

Overview

Premium
Total monthly premium$16.80
Health plan premium$0.00
Drug plan premium$16.80
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductibleComing soon
Drug plan deductible$435.00
Estimated yearly costs
Estimated total yearly costs for care$4,648.00
Out-of-pocket max
Out-of-pocket max$10,000 In and Out-of-network
$6,700 In-network

Benefits & costs

Doctor services
Primary doctor visitIn-network: 20% per visit
Out-of-network: 20% per visit
Specialist visitIn-network: 20% per visit
Out-of-network: 20% per visit
Tests, labs, & imaging
Diagnostic tests & proceduresIn-network: $0 or 20%
Out-of-network: $0 or 20%
Lab servicesIn-network: $0 or 20%
Out-of-network: $0 or 20%
Diagnostic radiology services (like MRI)In-network: 20%
Out-of-network: 20%
Outpatient x-raysIn-network: 20%
Out-of-network: 20%
Emergency care$90 per visit (always covered)
Urgent care20% per visit (always covered)
Hospital services
Inpatient hospital coverageIn-network: $1,969 per stay
Out-of-network: $1,969 per stay
Outpatient hospital coverageIn-network: 20% per visit
Out-of-network: 20% per visit
Skilled nursing facility
Skilled nursing facilityIn-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Preventive services
Preventive servicesIn-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulanceIn-network: 20%
Out-of-network: 20%
Therapy services
Occupational therapy visitIn-network: 20%
Out-of-network: 20%
Physical therapy & speech & language therapy visitIn-network: 20%
Out-of-network: 20%
Mental health services
Outpatient group therapy with a psychiatristIn-network: 20%
Out-of-network: 20%
Outpatient individual therapy with a psychiatristIn-network: 20%
Out-of-network: 20%
Outpatient group therapy visitIn-network: 20%
Out-of-network: 20%
Outpatient individual therapy visitIn-network: 20%
Out-of-network: 20%
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)In-network: 20% per item
Out-of-network: 20% per item
Prosthetics (like braces, artificial limbs)In-network: 20% per item
Out-of-network: 20% per item
Diabetes suppliesIn-network: $0 or 20% per item
Out-of-network: $0 or 20% per item

Extra benefits & costs

Hearing
Hearing examIn-network: 20%
Out-of-network: 20%
Fitting/evaluationIn-network: $0
Out-of-network: $0 copay
Hearing aids - All typesIn-network: $0 copay
Out-of-network: $0 copay
Preventive dental
Oral examIn-network: $0 copay
Out-of-network: $0 copay
CleaningIn-network: $0 copay
Out-of-network: $0 copay
Fluoride treatmentIn-network: $0 copay
Out-of-network: $0 copay
Dental x-raysIn-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Non-routine servicesIn-network: $0
Out-of-network: $0 copay
Diagnostic servicesNot covered
Restorative servicesIn-network: $0
Out-of-network: $0 copay
EndodonticsIn-network: $0
Out-of-network: $0 copay
PeriodonticsIn-network: $0
Out-of-network: $0 copay
ExtractionsIn-network: $0
Out-of-network: $0 copay
Prosthodontics, other oral/maxillofacial surgery, other servicesIn-network: $0
Out-of-network: $0 copay
Vision
Routine eye examIn-network: $0
Out-of-network: $0 copay
Contact lensesIn-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)Not covered
Eyeglass lenses (only)Not covered
UpgradesNot covered
More benefits
Fitness benefitLimited coverage
Transportation services for non-emergency care: Any health-related locationsNot covered
Transportation services for non-emergency care: Plan-approved locationsLimited coverage
Over the counter drug benefitsLimited coverage
In-home support servicesNot covered
Routine chiropractic serviceLimited coverage
Home and bathroom safety devicesNot covered
Meals for short durationLimited coverage
Annual physical examsLimited coverage
TelehealthLimited coverage

Drug coverage & costs

Part B drugs
Chemotherapy drugsIn-network: 20%
Out-of-network: $0 or 20%
Other Part B drugsIn-network: $0 or 20%
Out-of-network: $0 or 20%

Coverage Area for Humana Value Plus H5216-199 (PPO)

StateNew Mexico
CountyBernalillo

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$4 copay$10 copay$4 copay$10 copay
Tier 2: Non-Preferred Generic$16 copay$20 copay$16 copay$20 copay
Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Brand Name50% coinsurance50% coinsurance50% coinsurance50% coinsurance
Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance25% 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$12 copay$30 copay$0 copay$30 copay
Tier 2: Non-Preferred Generic$48 copay$60 copay$0 copay$60 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$131 copay$141 copay
Tier 4: Non-Preferred Brand Name50% coinsurance50% coinsurance50% coinsurance50% coinsurance
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 assessmentNot Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Rheumatoid arthritis management
Reducing the risk of falling
Improving bladder control
Medication reconciliation post-discharge
Plan all-cause readmissions
Statin Therapy for Patients with Cardiovascular Disease

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
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 availability
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
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
Medication adherence for diabetes medications
Medication adherence for hypertension - RAS antagonists
Medication adherence for cholesterol - Statins
MTM program completion rate for CMR
Statin use in persons with diabetes - SUPD

Physicians that accept Humana Value Plus H5216-199 (PPO) for New Mexico

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Lynn, Dozeman
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Fredie, Diaz
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Galen, Loughrey
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Adela, Tam
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Benjamin, Buxton
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Delfino, Candelaria
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Celia, Valdez
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Santiago, Macias
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Angela, Gallegos-macias
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Valerie, Romero-leggott
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Santana, Fontana
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Natalie, Debassige
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Silaja, Cheruvu
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Liana, Ponce
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Will, Kaufman
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Vanessa Cook, Jacobsohn
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Leena, Cherukuri
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Ramon, Duarte
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Samir, Kassicieh
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Charles, Benton
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Rebekah, Fu
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Robin, Napoleone
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Edward, Lamon
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Lynn Dozeman, MD
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  • Phone Number
    (505) 831-2534
  • Office Locations
    6900 Gonzales Rd Sw
    Albuquerque, NM 87121
6900 Gonzales Rd Sw Albuquerque NM, 87121
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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).

Medicare Plans Found

 

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).