HumanaChoice H5216-023 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5216-023
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HumanaChoice H5216-023 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5216-023
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
HumanaChoice H5216-023 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5216-023
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
$36.00
Monthly Premium
Ohio Counties Served
Darke Preble Clark Champaign Montgomery Miami Shelby Greene Stark Hamilton Franklin Butler Carroll Brown Union Trumbull Warren Fairfield Pickaway Licking Madison Mahoning Ashland Tuscarawas Clermont Delaware Morrow Columbiana Richland Holmes Wayne Hocking Perry Clinton Guernsey Coshocton Jefferson Noble Lawrence Athens Scioto Highland Morgan Fayette Meigs Pike Washington Jackson Gallia Adams Harrison Vinton Muskingum Knox Ashtabula Ross
Pennsylvania Counties Served
Lawrence Mercer
Indiana Counties Served
Dearborn Franklin Ohio Switzerland
Kentucky Counties Served
Boone Campbell Kenton
Basic Costs and Coverage
Coverage | Cost |
---|---|
Monthly Deductible | $100 |
Out of Pocket Max | In-Network: $6200 Out-of-Network: N/A |
Initial Coverage Limit | $5030 |
Catastrophic Coverage Limit | $8,000 |
Primary Care Doctor Visit | In-Network: Doctor Office Visit: Out-of-Network: Doctor Office Visit: |
Specialty Doctor Visit | In-Network: Doctor Specialty Visit: Out-of-Network: Doctor Specialty Visit: |
Inpatient Hospital Care | In-Network: Acute Hospital Services: Out-of-Network: |
Urgent Care | Copayment for Urgent Care $60.00 Worldwide Coverage: |
Emergency Room Visit | Copayment for Emergency Care $120.00 Worldwide Coverage: |
Ambulance Transportation | In-Network: Ground Ambulance: Air Ambulance: Please see Evidence of Coverage for Prior Authorization rules Out-of-Network: Ambulance Services: |
Health Care Services and Medical Supplies
HumanaChoice H5216-023 (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
Coverage | Cost |
---|---|
Chiropractic Services | In-Network: Out-of-Network: |
Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Out-of-Network: |
Durable Medical Eqipment (DME) | In-Network: Out-of-Network: |
Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Outpatient Diag/Therapeutic Rad Services: Out-of-Network: Outpatient Diag Procs/Tests/Lab Services: |
Home Health Care | In-Network: Out-of-Network: |
Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: Out-of-Network: |
Mental Health Outpatient Care | In-Network: Out-of-Network: |
Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Outpatient Observation Services: Ambulatory Surgical Center Services: Out-of-Network: Outpatient Hospital and ASC Services: |
Outpatient Substance Abuse Care | In-Network: Out-of-Network: |
Over-the-counter (OTC) Items | In-Network: Over-The-Counter (OTC) Items: Out-of-Network: Over-The-Counter (OTC) Items: |
Podiatry Services | In-Network:
Prior Authorization Required for Podiatry Services Out-of-Network: |
Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: Out-of-Network: |
Dental Benefits
The following dental services are covered from in-network providers.
Coverage | Cost |
---|---|
Dental Care | In Network: Out of Network: |
Vision Benefits
The following vision services are covered from in-network providers.
Coverage | Cost |
---|---|
Vision Benefits | In-Network: Eye Exams:
Maximum Plan Benefit of $75.00 every year for in and out of network services combined for Eye Exams and Eyewear combined Eyewear:
Copayment for Eyeglasses (lenses and frames) $0.00
Prior Authorization Required for Eyewear Out-of-Network: Medicare Covered Vision Services: |
Hearing Benefits
The following hearing services are covered from in-network providers.
Coverage | Cost |
---|---|
Hearing Benefits | In-Network: Hearing Exams:
Copayment for Fitting/Evaluation for Hearing Aid $0.00 Hearing Aids:
$399 copayment per ear per year for standard level hearing aid purchase or $699 copayment per ear per year for advanced level hearing aid purchase or $999 copayment per ear per year for premium level hearing aid purchase. Out-of-Network: Medicare Covered Hearing Services: |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
Coverage | Cost |
---|---|
Preventive Services and Health/Wellness Education Programs | In-Network: Abdominal aortic aneurysm screening
Tobacco use cessation Out-of-Network: Medicare-covered Zero Dollar Preventive Services: |
Prescription Drug Costs and Coverage
The HumanaChoice H5216-023 (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $100 (excludes Tiers 1 and 2) per year.
Coverage | Cost |
---|---|
Coverage & Cost | |
Annual Drug Deductible | $100 (excludes Tiers 1 and 2) |
Preferred Generic |
|
Generic |
|
Annual Drug Deductible | $100 (excludes Tiers 1 and 2) |
Preferred Generic |
|
Generic |
|
Annual Drug Deductible | $100 (excludes Tiers 1 and 2) |
Preferred Generic |
|
Generic |
|
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