H5216-345 HumanaChoice (PPO) Plan

Looking for details on the HumanaChoice H5216-345 (PPO) Plan? This article cuts through the clutter to outline crucial aspects like eligibility, in-network service coverage, and the unique advantage of a $0 premium for those in Georgia and South Carolina.

Here, you’ll learn about the cost efficiencies and comprehensive care distinct to the H5216-345 plan, equipping you with the information needed to assess its value for your healthcare needs.

Key Takeaways

• The HumanaChoice H5216-345 (PPO) is a Medicare Advantage Plan that offers a wide range of in-network services, including those not typically covered by Original Medicare and requires beneficiaries to be enrolled in both Medicare Part A and Part B.

• HumanaChoice H5216-345 offers $0 monthly premiums with an annual possibility of change, a $100 Part B premium rebate, and covers additional services and benefits like emergency care, diagnostics, and preventive services with low or no copayments.

• The plan includes comprehensive prescription drug coverage for a variety of medications, optional supplemental benefits for dental, vision, and hearing care, and enables beneficiaries to manage costs with a $0 deductible and a maximum out-of-pocket limit.

Exploring HumanaChoice H5216-345: A Medicare Advantage Overview

The HumanaChoice H5216-345 (PPO) is a Medicare Advantage Plan provided by Humana Inc.

This plan distinguishes itself from other Medicare Advantage plans by offering a wide range of services in-network, such as coverage for durable medical equipment and potentially prescription drugs that are not typically covered by Original Medicare.

Plan Structure and Enrollment Essentials

As a PPO Medicare Advantage plan, HumanaChoice H5216-345 provides coverage for a diverse range of services. To qualify for this plan, you must be enrolled in both Medicare Part A and Part B.

The plan is accessible to Medicare beneficiaries in Georgia and South Carolina, offering coverage for specific services with a cost per day for a specific number of days.

Understanding Your Monthly Premiums

HumanaChoice H5216-345 comes with a monthly premium of $0.00. However, it’s important to note that this premium is recalculated annually and may change from year to year. Currently, there is a $100 Part B monthly premium rebate (or giveback) available for this plan.

The monthly premium may be influenced by factors such as eligibility, discounts, and other plan-specific considerations.

Services and Benefits Under the H5216-345 Umbrella

A broad spectrum of services and benefits are covered under the HumanaChoice H5216-345 plan. These include supplementary benefits and services that may not be encompassed by Original Medicare (Medicare Part A and Part B).

Additionally, the plan offers health benefits such as $0 copayment for emergency diagnostic exams and specific dental services.

Inpatient and Outpatient Coverage

The terms ‘inpatient’ and ‘outpatient’ in Medicare Advantage plans refer to the type of care a patient receives. Inpatient services pertain to hospital care for patients who have been formally admitted to the hospital, whereas outpatient services entail receiving services from a hospital outpatient department or clinic without being admitted as an inpatient.

The copayments for Medicare-covered diagnostic procedures and tests under the HumanaChoice H5216-345 plan vary from $0.00 to $105.00, and for lab services, they range from $0.00 to $60.00. The copayments for Medicare-covered home health services under the plan amount to $0.00.

Preventative Services and Wellness Programs

Preventive screenings, vaccines, and an abdominal aortic aneurysm screening are among the preventive services covered under the HumanaChoice H5216-345 plan.

Additionally, the plan provides wellness education programs and includes coverage for Medicare Covered Preventive Services, with the goal of fostering holistic well-being for its members.

Managing Costs with HumanaChoice H5216-345

With HumanaChoice H5216-345, out-of-pocket costs can be managed by leveraging the $0 deductible and adhering to the annual out-of-pocket maximum limit.

Furthermore, staying well-informed about the potential Medicare expenses related to one’s health conditions is crucial for cost management and understanding cost sharing.

Additionally, the plan provides supplementary benefits and services that might not be included in Original Medicare, potentially leading to additional cost savings for recipients.

Navigating Your Plan Deductible

The deductible amount for the HumanaChoice H5216-345 Medicare Advantage Plan is $0. Although there is no deductible, plan holders have access to programs provided by the plan to effectively manage their healthcare services.

The plan does not require a deductible for prescription drug coverage, thus enabling members to have first-dollar coverage.

For a multi-person household enrolled in the HumanaChoice H5216-345 plan, the deductible is $0, indicating that the household can avail of covered services without being concerned about a deductible.

Controlling Out-of-Pocket Expenses

The out-of-pocket expenses for HumanaChoice H5216-345 are as follows:

• $0 deductible

• Maximum out-of-pocket limit of $8700

• No co-payment requirements for primary doctor visits

• $40 co-payment per visit for specialist visits

• $100 co-payment per visit for ER visits

The prescription drug plan included in this PPO also features $0 co-payment for preferred generic, generic, and preferred brand drugs.

To reduce out-of-pocket costs, it is crucial to carefully examine the coverage of your plan to determine which services are included, select in-network healthcare providers, choose generic medications, and stay informed about any modifications to the plan’s network and formulary.

Specialized Care Coverage Specifics

A range of specialized care is covered under the HumanaChoice H5216-345 plan. This includes chiropractic services with a copayment of $15.00 for Medicare-covered services and podiatry services with a copayment of $40.00 for Medicare-covered services. Both categories of services necessitate prior authorization.

The plan provides coverage for inpatient mental health care at the psychiatric hospital for up to 190 days, with a copayment of $587 per day for days. It also includes outpatient mental health services with a copay of $45 for Medicare-covered individual therapy sessions.

Mental Health Services and Substance Abuse Treatment

HumanaChoice H5216-345 provides coverage for both inpatient and outpatient mental health services, which encompass outpatient individual therapy sessions with a psychiatrist. A copayment of $45.00 is applicable for Medicare-covered individual sessions.

The plan also offers coverage for outpatient substance abuse treatment services. There are copayments for Medicare-covered individual sessions, ranging from $45.00 to $100.00, and prior authorization is necessary for these services.

Podiatry and Chiropractic Services

The HumanaChoice H5216-345 plan encompasses coverage for podiatry services that consist of in-network care with a copayment of $40 for Medicare-covered services. This coverage encompasses orthotics and other foot care devices. Prior authorization is necessary for podiatry services.

Chiropractic services under the H5216-345 plan encompass Medicare-covered services with a copayment of $15.00. However, it is important to note that there is a maximum of 1 chiropractic visit covered per year.