2018 HumanaChoice H5216-084 (PPO) H5216-84-0 in SD from Humana | HealthPocket

HumanaChoice H5216-084 (PPO)

Medicare Advantage Plan for South Dakota

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5216-84-0
CMS Rating1
Plan TypePPO
Annual Deductible$399.00

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?
Yes
Health Plan Deductible
$1,000 annual deductible
Monthly Drug Plan Premium
$20.90
Monthly Health Plan Premium
$43.10

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:
$400 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:
$0-95
Out-of-Network:
50%
Lab services:
In-Network:
$0-10
Out-of-Network:
50%
Diagnostic radiology services (e.g., MRI):
In-Network:
$35-400
Out-of-Network:
50%
Outpatient x-rays:
In-Network:
$10-95
Out-of-Network:
50%
Mental health services
In-Network:
$318 for days 1 through 5
$0 for days 6 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 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:
$40
Out-of-Network:
50%
Physical therapy and speech and language therapy visit:
In-Network:
$40
Out-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:
$45
Out-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:
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 drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
50%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
50%

Coverage Area for HumanaChoice H5216-084 (PPO)

StateSouth Dakota
CountyLincoln

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$5 copay$10 copay$5 copay
Tier 2: Non-Preferred Generic$15 copay$20 copay$15 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$15 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$45 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

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 H5216-084 (PPO) for South Dakota

/
Hanssen, Kimberly
2100 S Marion Rd
Sioux Falls, SD 57106
Feistner-leuning, Heidi
2100 S Marion Rd
Sioux Falls, SD 57106
Day, Richard
7220 W 41st St
Sioux Falls, SD 57106
Hoyme, Krista
7220 W 41st St
Sioux Falls, SD 57106
Uthe, Craig
3401 W 49th St
Sioux Falls, SD 57106
Brooks, Patricia
3401 W 49th St
Sioux Falls, SD 57106
Hultgren, Kari
2100 S Marion Rd
Sioux Falls, SD 57106
Boyens, Scott
3401 W 49th St
Sioux Falls, SD 57106
Sorensen, Todd
3401 W 49th St
Sioux Falls, SD 57106
Donelan, Timothy
3401 W 49th St
Sioux Falls, SD 57106
Pederson, Kim
2100 S Marion Rd
Sioux Falls, SD 57106
Bunde, Elinor
3401 W 49th St
Sioux Falls, SD 57106
Thury, Chad
2100 S Marion Rd
Sioux Falls, SD 57106
Seurer, Joseph
2100 S Marion Rd
Sioux Falls, SD 57106
Meyer, Jeffry
3401 W 49th St
Sioux Falls, SD 57106
Heath, Robert
3217 S Carolyn Ave
Sioux Falls, SD 57106
Palmer, Bradley
7220 W 41st St
Sioux Falls, SD 57106
Peterson-henry, Terri
7220 W 41st St
Sioux Falls, SD 57106
Eich, Shari
2100 S Marion Rd
Sioux Falls, SD 57106
Dehaan, Douglas
7220 W 41st St
Sioux Falls, SD 57106
Jundt, Kim
2100 S Marion Rd
Sioux Falls, SD 57106
Prestbo, Leah
2100 S Marion Rd
Sioux Falls, SD 57106
Griffin, Brent
7220 W 41st St
Sioux Falls, SD 57106
Rodriguez, Gabriel
3900 W 41st St
Sioux Falls, SD 57106
Details
Kimberly Hanssen, DO
Phone Number
(605) 361-7208
Office Locations
2100 S Marion Rd
Sioux Falls, SD 57106
2100 S Marion Rd Sioux Falls SD, 57106

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