2018 HumanaChoice H5525-005 (PPO) H5525-5-0 in PA from Humana | HealthPocket

HumanaChoice H5525-005 (PPO)

$77/mo

Apply For This Plan

Zip Code19120
Applicant12/10/1983 Male
Coverage Start12/11/2018
Apply Now

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5525-5-0
Plan Year2018
CMS Rating
Plan TypePPO
Annual Deductible$0.00

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan

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

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsNo
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$1,000 annual deductible
Monthly Drug Plan Premium$21.00
Monthly Health Plan Premium$56.00

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:
$350 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Out-of-Network:
30% per stay
Outpatient hospital coverageIn-Network:
$350 per visit
Out-of-Network:
30% per visit
Doctor visitsPrimary:
In-Network:
$15 per visit
Out-of-Network:
30% per visit
Specialist:
In-Network:
$45 per visit
Out-of-Network:
30% per visit
Preventive careIn-Network:
$0 copay
Out-of-Network:
$0 or 30%
Emergency care/Urgent careEmergency:
$80 per visit (always covered)
Urgent care:
$15-45 or 30% per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:
$0-105
Out-of-Network:
30%
Lab services:
In-Network:
$0-40
Out-of-Network:
30%
Diagnostic radiology services (e.g., MRI):
In-Network:
$45-350
Out-of-Network:
30%
Outpatient x-rays:
In-Network:
$15-100
Out-of-Network:
30%
Mental health servicesIn-Network:
$350 for days 1 through 4
$0 for days 5 through 90
Out-of-Network:
30% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
30%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
30%
Outpatient group therapy visit:
In-Network:
$40
Out-of-Network:
30%
Outpatient individual therapy visit:
In-Network:
$40
Out-of-Network:
30%
Skilled Nursing FacilityIn-Network:
$0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network:
30% per stay
Rehabilitation servicesOccupational therapy visit:
In-Network:
$15-40
Out-of-Network:
30%
Physical therapy and speech and language therapy visit:
In-Network:
$15-40
Out-of-Network:
30%
AmbulanceIn-Network:
$265 or 20%
Out-of-Network:
$265 or 20%
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:
$45
Out-of-Network:
30%
Routine foot care:
Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
15% per item
Out-of-Network:
20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
30% per item
Diabetes supplies:
In-Network:
$0 or 10-20% per item
Out-of-Network:
30% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:
20%
Out-of-Network:
30%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
30%

Coverage Area for HumanaChoice H5525-005 (PPO)

StatePennsylvania
CountyPhiladelphia

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 Tier33% coinsurance33% coinsurance33% 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

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 HumanaChoice H5525-005 (PPO) for Pennsylvania

/
Please select the correct zip
Nguyen, Kenneth
View All Details
Small, Ronald
View All Details
Casto, Daniel
View All Details
Matson, David
View All Details
Itskov, Boris
View All Details
Yoo, Stanley
View All Details
Florendo, Maria Emilia
View All Details
Infante-gutierrez, Guillermo
View All Details
Nguyen, Truong
View All Details
Myers, John
View All Details
Garcia, Laureano
View All Details
Parker, Sophie
View All Details
Richardson, Thomas
View All Details
Jaffe, Richard
View All Details
Cosgrove, Douglas
View All Details
Rosenstein, Kenneth
View All Details
Otero-perez, Guillermo
View All Details
Kenneth Nguyen, M.D.
View All Details
  • Phone Number
    (215) 324-2180
  • Office Locations
    448 E Wyoming Ave
    Philadelphia, PA 19120
448 E Wyoming Ave Philadelphia PA, 19120

get free advice

Speak With A Licensed Agent

Call (800) 931-6467

Learn More

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.