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2023 HumanaChoice H5216-157 (PPO)

HumanaChoice H5216-157 (PPO) H5216-157 is a 2023 Medicare Advantage Plan or Part-C by Humana available to residents in South Carolina and Georgia. This plan does not provide extra prescription drug (Part-D) coverage. Humana HumanaChoice H5216-157 (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $6,100 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $6,100 out-of-pocket. This can be an extremely nice safety net.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for HumanaChoice H5216-157 (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With 2023 Medicare Advantage Plan 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 if you sign up for Medicare Advantage in South Carolina or Medicare Advantage in Georgia.



2023 Humana Medicare Advantage Plan Overview

Name:HumanaChoice H5216-157 (PPO)
Plan ID:H5216 157 0
Provider:Humana
Year:2023
Type:Local PPO *
Combined Premium (C+D):$0/mo
MOOP:$6,100/yr
Similar Plan: H5216-160




What type of plan is HumanaChoice H5216-157 (PPO)

HumanaChoice H5216-157 (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.

How much does HumanaChoice H5216-157 (PPO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Humana charges a $0 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.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. HumanaChoice H5216-157 (PPO) by Humana MOOP is $6,100. Once you spend $6,100 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.





2023 Summary of Benefits


The benefit information provided is a summary of what HumanaChoice H5216-157 (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Humana helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)Covered


Contact lenses


In-Network Vision$0 copay
Out-of-Network Vision$0 copay


Eyeglass frames


VisionNot covered


Eyeglass lenses


VisionNot covered


Eyeglasses (frames and lenses)


In-Network Vision$0 copay
Out-of-Network Vision$0 copay


Other


VisionNot covered


Routine eye exam


In-Network Vision$0 copay
Out-of-Network Vision$0 copay


Upgrades


VisionNot covered



Out-of-Network Transportation50% coinsurance
In-Network Transportation$0 copay
In-Network Skilled Nursing Facility$0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-Network Skilled Nursing Facility30% per stay


Occupational therapy visit


In-Network Rehabilitation services$25-40 copay
Out-of-Network Rehabilitation services30% coinsurance


Physical therapy and speech and language therapy visit


Out-of-Network Rehabilitation services30% coinsurance
In-Network Rehabilitation services$25-40 copay


Cleaning


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental$0 copay


Dental x-ray(s)


Out-of-Network Preventive dental$0 copay
In-Network Preventive dental$0 copay


Fluoride treatment


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental$0 copay


Oral exam


Out-of-Network Preventive dental$0 copay
In-Network Preventive dental$0 copay



In-Network Preventive care$0 copay
Out-of-Network Preventive care$0 copay or 30% coinsurance
Out-of-Network Outpatient hospital coverage30% coinsurance per visit
In-Network Outpatient hospital coverage$0-345 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo


Inpatient hospital - psychiatric


Out-of-Network Mental health services50% per stay
In-Network Mental health services$587 per day for days 1 through 3
$0 per day for days 4 through 90


Outpatient group therapy visit


In-Network Mental health services$40 copay
Out-of-Network Mental health services30% coinsurance


Outpatient group therapy visit with a psychiatrist


Out-of-Network Mental health services30% coinsurance
In-Network Mental health services$40 copay


Outpatient individual therapy visit


In-Network Mental health services$40 copay
Out-of-Network Mental health services30% coinsurance


Outpatient individual therapy visit with a psychiatrist


Out-of-Network Mental health services30% coinsurance
In-Network Mental health services$40 copay


Chemotherapy


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs30% coinsurance


Other Part B drugs


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs30% coinsurance


Diabetes supplies


Out-of-Network Medical equipment/supplies30% coinsurance per item
In-Network Medical equipment/supplies$0 copay or 10-20% coinsurance per item


Durable medical equipment (e.g., wheelchairs, oxygen)


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies20% coinsurance per item


Prosthetics (e.g., braces, artificial limbs)


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies30% coinsurance per item



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network
$6,100 In-network
In-Network Inpatient hospital coverage$245 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91 and beyond
Out-of-Network Inpatient hospital coverage30% per stay


Fitting/evaluation


Out-of-Network Hearing$0 copay
In-Network Hearing$0 copay


Hearing aids


In-Network Hearing$399-699 copay
Out-of-Network Hearing$399-699 copay


Hearing exam


Out-of-Network Hearing30% coinsurance
In-Network Hearing$45 copay



Health plan deductible$0
Out-of-Network Ground ambulance$270 copay
In-Network Ground ambulance$270 copay


Foot exams and treatment


Out-of-Network Foot care (podiatry services)30% coinsurance
In-Network Foot care (podiatry services)$45 copay


Routine foot care


Foot care (podiatry services)Not covered


Emergency


Emergency care/Urgent care$90 copay per visit (always covered)


Urgent care


Emergency care/Urgent care$45 copay per visit (always covered)


Primary


In-Network Doctor visits$5 copay per visit
Out-of-Network Doctor visits30% coinsurance per visit


Specialist


In-Network Doctor visits$45 copay per visit
Out-of-Network Doctor visits30% coinsurance per visit


Diagnostic radiology services (e.g., MRI)


Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0-300 copay


Diagnostic tests and procedures


In-Network Diagnostic procedures/lab services/imaging$0-100 copay
Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance


Lab services


In-Network Diagnostic procedures/lab services/imaging$0-45 copay
Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance


Outpatient x-rays


Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance
In-Network Diagnostic procedures/lab services/imaging$5-100 copay


Diagnostic services


In-Network Comprehensive dental$0 copay
Out-of-Network Comprehensive dental$0 copay


Endodontics


In-Network Comprehensive dental$0 copay
Out-of-Network Comprehensive dental$0 copay


Extractions


In-Network Comprehensive dental$0 copay
Out-of-Network Comprehensive dental$0 copay


Non-routine services


Out-of-Network Comprehensive dental$0 copay
In-Network Comprehensive dental$0 copay


Periodontics


Out-of-Network Comprehensive dental$0 copay
In-Network Comprehensive dental$0 copay


Prosthodontics, other oral/maxillofacial surgery, other services


In-Network Comprehensive dental$0 copay
Out-of-Network Comprehensive dental$0 copay


Restorative services


Out-of-Network Comprehensive dental$0 copay
In-Network Comprehensive dental$0 copay



In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?Yes, contact plan for further details




HumanaChoice H5216-157 (PPO) Reviews


Is HumanaChoice H5216-157 (PPO) a good plan? HumanaChoice H5216-157 (PPO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare HumanaChoice H5216 157 Reviews among several different plans.

2022 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H5216-157 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Humana

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for HumanaChoice H5216-157 (PPO) requires you to live in that plan’s service area. The service area is listed below:

State: South Carolina Medicare

Georgia Medicare


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How much does HumanaChoice H5216-157 (PPO) cost?

Humana charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is HumanaChoice H5216-157 (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. HumanaChoice H5216-157 (PPO) by Humana MOOP is $6,100. Once you spend $6,100 you will pay nothing for Part A or Part B covered services.

What type of plan is HumanaChoice H5216-157 (PPO)?

HumanaChoice H5216-157 (PPO) is a Local PPO *. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.

Is HumanaChoice H5216-157 (PPO) a good plan?

HumanaChoice H5216-157 (PPO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.