2021 HumanaChoice H5216-103 (PPO) H5216-103-000 in ND from Humana | HealthPocket

HumanaChoice H5216-103 (PPO)

$115/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5216-103-000
Plan Year2021
CMS Rating
Plan TypePPO
Annual Deductible$250.00
Out-of-Pocket Maximum3500

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

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

Costs and Other Important Information

Plan Year2021
Prescription Drugs Covered?Yes
Health Plan Deductible$250
Monthly Drug Plan Premium$34.1
Monthly Health Plan Premium$80.9

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: Generic$15 copay$20 copay$15 copay$20 copay
Tier 3: Preferred Brand$47 copay$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Drug$100 copay$100 copay$100 copay$100 copay
Tier 5: Specialty Tier28% coinsurance28% coinsurance28% coinsurance28% coinsurance

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: Generic$45 copay$60 copay$0 copay$60 copay
Tier 3: Preferred Brand$141 copay$141 copay$131 copay$141 copay
Tier 4: Non-Preferred Drug$300 copay$300 copay$290 copay$300 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 management
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
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 HumanaChoice H5216-103 (PPO) for North Dakota

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John, Erie
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Donald, Matthees
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Sarah, Jordan
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Margaret, Savage
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Rachael, Carlisle
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Sierra, Kahler
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Ashley, Rogers
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Olivia, Huber
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Brianna, Jastram
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Joni, Hjalmquist
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Marina, Gilca
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Kayla, Flach
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Amanda, Lachance
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Stacy, Levang
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Shruti, Kanwar
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Shanthakumari, Jinnur
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Stephanie, Antony
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Enrique, Tobias Pader
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Joshua, Honeyman
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Allison, Hetland
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Jacob, Fish
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Rohit, Mahajan
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Aaron, Stinton
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John Erie, MD
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  • Phone Number
    (701) 364-8000
  • Office Locations
    3000 32nd Ave S
    Fargo, ND 58103
3000 32nd Ave S Fargo ND, 58103
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HealthPocket.com is a free information source. 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. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.