2018 HumanaChoice H5216-126 (PPO) H5216-126-0 in VA from Humana | HealthPocket

HumanaChoice H5216-126 (PPO)

$117/mo

Apply For This Plan

Zip Code23464
Applicant12/11/1983 Male
Coverage Start12/12/2018
Apply Now

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5216-126-0
Plan Year2018
CMS Rating
Plan TypePPO
Annual Deductible$190.00

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

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

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsYes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network $3,500 In-network
Other health plan deductibles?No
Health Plan Deductible$500 annual deductible
Monthly Drug Plan Premium$23.70
Monthly Health Plan Premium$93.30

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:
$150 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Out-of-Network:
$150 for days 1 through 5
$0 for days 6 through 90
Outpatient hospital coverageIn-Network:
$150 per visit
Out-of-Network:
$150 per visit
Doctor visitsPrimary:
In-Network:
$5 per visit
Out-of-Network:
$5-100 per visit
Specialist:
In-Network:
$30 per visit
Out-of-Network:
$30 per visit
Preventive careIn-Network:
$0 copay
Out-of-Network:
$0 copay
Emergency care/Urgent careEmergency:
$80 per visit (always covered)
Urgent care:
$5-30 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:
$0-90
Out-of-Network:
$0-90
Lab services:
In-Network:
$0-45
Out-of-Network:
$0-90
Diagnostic radiology services (e.g., MRI):
In-Network:
$30-150
Out-of-Network:
$30-150
Outpatient x-rays:
In-Network:
$5-100
Out-of-Network:
$5-100
Mental health servicesIn-Network:
$150 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
$150 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
In-Network:
$30
Out-of-Network:
$30
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$30
Out-of-Network:
$30
Outpatient group therapy visit:
In-Network:
$30
Out-of-Network:
$30
Outpatient individual therapy visit:
In-Network:
$30
Out-of-Network:
$30
Skilled Nursing FacilityIn-Network:
$0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network:
$0 for days 1 through 20
$167.50 for days 21 through 100
Rehabilitation servicesOccupational therapy visit:
In-Network:
$10-40
Out-of-Network:
$10-40
Physical therapy and speech and language therapy visit:
In-Network:
$10-40
Out-of-Network:
$10-40
AmbulanceIn-Network:
$265 or 20%
Out-of-Network:
$265 or 20%
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:
$30
Out-of-Network:
$30
Routine foot care:
Not covered
Medical equipment/suppliesDurable 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:
$10 or 20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:
20%
Out-of-Network:
20%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
20%

Coverage Area for HumanaChoice H5216-126 (PPO)

StateVirginia
CountyChesapeake City

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$4 copay$10 copay$4 copay
Tier 2: Non-Preferred Generic$12 copay$20 copay$12 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$12 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$36 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 H5216-126 (PPO) for Virginia

/
Please select the correct zip
Fayton, Charles
View All Details
Chung, Michael
View All Details
Espada, Francisco
View All Details
Beatty, Maxine
View All Details
Drabik, Ashley
View All Details
Forgey, Elizabeth
View All Details
Hinshaw, Mary
View All Details
Mechtel, Lauren
View All Details
Pitcher, Susan
View All Details
Fuerst, Kathryn
View All Details
Healey, Kasie
View All Details
Mowfy, Brittany
View All Details
Grubbs, Meagan
View All Details
Smithson, Kayla
View All Details
Seal, Shana
View All Details
Hastings, Rebecca
View All Details
Ward, Brandy
View All Details
Daigle, Amanda
View All Details
Odom, Katelyn
View All Details
O'connor, Lauren
View All Details
Gellman, Jonathan
View All Details
Moretz, Jonathan
View All Details
Walters, Jeremy
View All Details
Warner, Allison
View All Details
Taylor-oliveira, Dana
View All Details
Charles Fayton, M.D.
View All Details
  • Phone Number
    (757) 420-6218
  • Office Locations
    6477 College Park Sq
    Virginia Beach, VA 23464
6477 College Park Sq Virginia Beach VA, 23464
Humana Gold Choice H8145-108 (PFFS)
COST:from $0CMS Rating:
Select
Anthem MediBlue Local (HMO)
COST:from $0CMS Rating:
Select
Innovation Health Medicare Connection Plan (HMO)
COST:from $0CMS Rating:Not Rated
Select
Aetna Medicare Select Plan (HMO)
COST:from $0CMS Rating:
Select
Virginia Premier Advantage Gold (HMO)
COST:from $0CMS Rating:Not Rated
Select

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.