HumanaChoice H5216-052 (PPO)

Medicare Advantage Plan for Ohio

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5216-52-1
CMS Rating1
Plan TypePPO
Annual Deductible$195.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
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
$0
Monthly Drug Plan Premium
$18.00
Monthly Health Plan Premium
$27.00

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$360 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Out-of-Network:
50% per stay
Outpatient hospital coverage
In-Network:
$360 per visit. Out-of-Network:
50% per visit
Doctor visits
Primary:In-Network:
$10 per visit. Out-of-Network:
50% per visit
Specialist:In-Network:
$45 per visit. Out-of-Network:
50% per visit
Preventive care
In-Network:
$0 copay. Out-of-Network:
$0 or 50%
Emergency care/Urgent care
Emergency:$80 per visit (always covered)
Urgent care:$10-45 or 50% per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:In-Network:
$0-105Out-of-Network:
20-50%
Lab services:In-Network:
$0-35Out-of-Network:
50%
Diagnostic radiology services (e.g., MRI):In-Network:
$45-360Out-of-Network:
50%
Outpatient x-rays:In-Network:
$10-95Out-of-Network:
50%
Mental health services
In-Network:
$360 for days 1 through 4
$0 for days 5 through 90
Out-of-Network:
50% per stay
Outpatient group therapy visit with a psychiatrist:In-Network:
$40Out-of-Network:
50%
Outpatient individual therapy visit with a psychiatrist:In-Network:
$40Out-of-Network:
50%
Outpatient group therapy visit:In-Network:
$40Out-of-Network:
50%
Outpatient individual therapy visit:In-Network:
$40Out-of-Network:
50%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network:
50% per stay
Rehabilitation services
Occupational therapy visit:In-Network:
$10-40Out-of-Network:
50%
Physical therapy and speech and language therapy visit:In-Network:
$10-40Out-of-Network:
50%
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:
$45Out-of-Network:
50%
Routine foot care:Not covered
Medical equipment/supplies
Durable 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 10-20% per item. Out-of-Network:
50% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:In-Network:
20%Out-of-Network:
20-50%
Other Part B drugs:In-Network:
20%Out-of-Network:
20-50%

Coverage Area for HumanaChoice H5216-052 (PPO)

StateOhio
CountyFranklin

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$7 copay$10 copay$7 copay
Tier 2: Non-Preferred Generic$17 copay$20 copay$17 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 Tier29% coinsurance29% coinsurance29% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$21 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$51 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

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 H5216-052 (PPO) for Ohio

/
KING, GRETZEL
104 N MURRAY HILL RD
COLUMBUS, OH 43228
LUKEN, THERESA
4300 CLIME RD
COLUMBUS, OH 43228
KUPER, ALICIA
700 CHILDRENS DR
COLUMBUS, OH 43205
LEVIN, HOWARD
5131 BEACON HILL RD
COLUMBUS, OH 43228
CARINE, ALI
4310 CLIME RD
COLUMBUS, OH 43228
CASTLE, LINDSAY
217 HARRISBURG AVE
LANCASTER, PA 17603
HINCKLEY, JOHN
5100 W BROAD ST
COLUMBUS, OH 43228
VINCENT, KAREN
5100 W BROAD ST
COLUMBUS, OH 43228
BOWERS, STUART
5141 W BROAD ST
COLUMBUS, OH 43228
LEVIN, SETH
5131 BEACON HILL RD
COLUMBUS, OH 43228
CUNAGIN, KIMBERLY
5100 W BROAD ST
COLUMBUS, OH 43228
MILLER, CAREN
5100 W BROAD ST
COLUMBUS, OH 43228
JORDAN, KEVIN
5100 W BROAD ST
COLUMBUS, OH 43228
FRASER, WILLIAM
5100 W BROAD ST
COLUMBUS, OH 43228
RYBALTOWSKI, MARIUSZ
5100 W BROAD ST
COLUMBUS, OH 43228
PARKER, SARAH
5100 W BROAD ST
COLUMBUS, OH 43228
HARRIS, PAUL
5193 W BROAD ST
COLUMBUS, OH 43228
JONES, BRUCE
5100 W BROAD ST
COLUMBUS, OH 43228
JONES, PAULA
5100 W BROAD ST
COLUMBUS, OH 43228
JOHNSEN, RONALD
5100 W BROAD ST
COLUMBUS, OH 43228
HAMILTON, DANA
111 INAH AVE
COLUMBUS, OH 43228
MORRISON, ROSEANN
5212 W. BROAD ST., STE F
COLUMBUS, OH 43228
BELL, PETER
5100 W BROAD ST
COLUMBUS, OH 43228
Details
GRETZEL KING
Phone Number
(614) 878-6413
Office Locations
104 N MURRAY HILL RD
COLUMBUS, OH 43228
104 N MURRAY HILL RD COLUMBUS OH, 43228

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