2022 Humana Value Plus H5216-199 (PPO)

Humana Value Plus H5216-199 (PPO) H5216-199 is a 2022 Medicare Advantage Plan or Part-C by Humana available to residents in New Mexico. This plan includes additional prescription drug (Part-D) coverage. The Humana Value Plus H5216-199 (PPO) has a monthly premium of $29.40 and has an in-network maximum out-of-pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out-of-pocket. This can be a extremely nice safety net.

Humana Value Plus H5216-199 (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Value Plus H5216-199 (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Humana Medicare Advantage Plan Costs

Humana Value Plus H5216-199 (PPO) Part-C Premium

Humana charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H5216-199 Part-D Deductible and Premium

Humana Value Plus H5216-199 (PPO) has a monthly drug premium of $29.40 and a $445.00 drug deductible. This Humana plan offers a $29.40 Part-D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Humana above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $29.40 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Humana Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Humana plan does not offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Humana Value Plus H5216-199 (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $7.30 for 75% low income subsidy $14.70 for 50% and $22.00 for 25%.

H5216-199 Formulary or Drug Coverage

Humana Value Plus H5216-199 (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Humana Value Plus H5216-199 (PPO) H5216-199 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$5	$10
Tier 2	$16	$20
Tier 3	$47	$47
Tier 4	$100	$100
Tier 5	25%	25%

*Initial Coverage Phase and 30 day supply

2021 Humana Value Plus H5216-199 (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	$0 copay
Endodontics	$0 copay (Out-of-Network)
Extractions	$0 copay
Extractions	$0 copay (Out-of-Network)
Non-routine services	$0 copay
Non-routine services	$0 copay (Out-of-Network)
Periodontics	$0 copay
Periodontics	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Restorative services	$0 copay (Out-of-Network)
Restorative services	$0 copay

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Deductible

Coming soon

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	20% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	20% coinsurance
Diagnostic tests and procedures	$0 copay or 20% coinsurance
Diagnostic tests and procedures	$0 copay or 20% coinsurance (Out-of-Network)
Lab services	$0 copay or 20% coinsurance
Lab services	$0 copay or 20% coinsurance (Out-of-Network)
Outpatient x-rays	20% coinsurance (Out-of-Network)
Outpatient x-rays	20% coinsurance

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Doctor Visits

Primary	20% coinsurance per visit (Out-of-Network)
Primary	20% coinsurance per visit
Specialist	20% coinsurance per visit (Out-of-Network)
Specialist	20% coinsurance per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	20% coinsurance per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	20% coinsurance
Foot exams and treatment	20% coinsurance (Out-of-Network)
Routine foot care	$0 copay
Routine foot care	$0 copay (Out-of-Network)

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Ground Ambulance

20% coinsurance
20% coinsurance (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	$0 copay (Out-of-Network)
Hearing aids	$0 copay (Out-of-Network)
Hearing aids	$0 copay
Hearing exam	20% coinsurance
Hearing exam	20% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

$1,665 per stay
$1,665 per stay (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	$0 copay or 20% coinsurance per item
Diabetes supplies	$0 copay or 20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	$0 copay or 20% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	$0 copay or 20% coinsurance (Out-of-Network)
Other Part B drugs	$0 copay or 20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$1,665 per stay (Out-of-Network)
Inpatient hospital - psychiatric	$1,665 per stay
Outpatient group therapy visit	20% coinsurance (Out-of-Network)
Outpatient group therapy visit	20% coinsurance
Outpatient group therapy visit with a psychiatrist	20% coinsurance
Outpatient group therapy visit with a psychiatrist	20% coinsurance (Out-of-Network)
Outpatient individual therapy visit	20% coinsurance (Out-of-Network)
Outpatient individual therapy visit	20% coinsurance
Outpatient individual therapy visit with a psychiatrist	20% coinsurance
Outpatient individual therapy visit with a psychiatrist	20% coinsurance (Out-of-Network)

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MOOP

$11,300 In and Out-of-network $7,550 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

20% coinsurance per visit
20% coinsurance per visit (Out-of-Network)

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Preventive Care

$0 copay
$0 copay (Out-of-Network)

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Preventive Dental

Cleaning	$0 copay
Cleaning	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Fluoride treatment	$0 copay
Fluoride treatment	$0 copay (Out-of-Network)
Oral exam	$0 copay
Oral exam	$0 copay (Out-of-Network)

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Rehabilitation Services

Occupational therapy visit	20% coinsurance (Out-of-Network)
Occupational therapy visit	20% coinsurance
Physical therapy and speech and language therapy visit	20% coinsurance
Physical therapy and speech and language therapy visit	20% coinsurance (Out-of-Network)

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Skilled Nursing Facility

$0 per day for days 1 through 20 $184 per day for days 21 through 100
$0 per day for days 1 through 20 $184 per day for days 21 through 100 (Out-of-Network)

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Transportation

50% coinsurance (Out-of-Network)
$0 copay

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Vision

Contact lenses	$0 copay (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	$0 copay (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Humana Value Plus H5216-199 (PPO) H5216

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Humana Value Plus H5216-199 (PPO) Plans Performance

Health Plan Customer Service Rating for Humana Value Plus H5216-199 (PPO)

Humana Value Plus H5216-199 (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Humana Value Plus H5216-199 (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.