|Part D Benefit:||Yes|
|Rx Gap Coverage:||N|
HumanaChoice H5216-042 is a Preferred Provider Organization Medicare Advantage Plan, by Humana, available in Taylor County, TX. It gives you freedom to choose your doctors, specialists and hospital facilities. Plus, you can keep your out of pocket costs as low as possible when you use the Humana network. You get predictable copayments and coinsurance, making it easier to keep your healthcare costs in check.
The monthly premium for this plan in Taylor County, TX is $87.00. This amount is paid directly to Humana.
This plan has a monthly premium because its cost is not full covered by the Medicare Part B premium. When you enroll in this plan, Social Security will continue to deduct Medicare Part B from your monthly payment. If you do not pay a penalty due to late enrollment penalty and your income is less than $85k ($170k for married couples) you'll pay the standard Medicare Part B premium.
In addition to the premiums you also pay your share when you use healthcare services. Each time you see your doctor, or if you are admitted as an inpatient (hospitalized), you'll pay copayments. Your prescription drugs also have a cost sharing component.
Maximum Out-of-Pocket Limit
There is a maximum out of pocket limit of $6,700 on your healthcare costs in 2018. This is commonly called the plan MOOP. The MOOP does not include your prescriptions or your monthly premium.
Although the mandatory MOOP limit is $6,700, Medicare allows for a lower “Voluntary MOOP” that can be as low as $3,400. This plan's MOOP is $6,700. Take this figure into as much consideration along with the premium and the copay.
If you are comparing this plan with Original Medicare, factor in that there are no out-of-pocket limits on Medicare Parts A and B. With Original Medicare you'll need a Medicare Supplement to cover what the government doesn't.
Coverage, Copayments & Coinsurance
The HumanaChoice H5216-042 plan offers the same basic benefits as Original Medicare. The big difference is copayments and coinsurances. Below you will find (where available) what you will pay for common health care services.
Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:
|Primary Care Doctor:||$15 co-payment|
|Physician Specialist:||$45 co-payment|
|Occupational Therapist:||$25 co-payment|
|Physical Therapist:||$40 co-payment|
|Speech Terapist:||$40 co-payment|
If you are admitted to a hospital or clinic for treatment and stay overnight, you are an inpatient. Most plans have tiered costs for inpatient treatment. Here's how this plan covers you:
- Day 1 to 5: $325
- Day 6 to 90: $0
The following preventative healthcare services are covered at no cost:
- Abdominal aortic aneurysm screening
- Alcohol misuse counseling
- Bone mass measurement
- Breast cancer screening (mammogram)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular screenings
- Cervical and vaginal cancer screening
- Colorectal cancer screenings
- Depression screening
- Diabetes screenings
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
- Welcome to Medicare preventive visit
- Yearly Wellness visit
Prescription Drug Coverage
This plan includes Medicare Part D coverage for your prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The Part D deductible on plan is $175.00. This is the amount you will pay until the plan begins to pay its portion.
Medicare Plan Rating
Medicare gave the HumanaChoice H5216-042 plan an average rating of -1.0 out of 5 stars. This rating is , by Medicare's definition.
Each Medicare Advantage plan receives a 1.0 to 5.0 star rating by Medicare (annually). The quality assessment of plans helps people considering enrollment. A plan with 5 stars has the highest quality.
Compare HumanaChoice H5216-042 with these top rated plans available in Taylor County:
- HumanaChoice H5216-128
- Humana Gold Choice H8145-084
- Humana Gold Choice H8145-126
- HumanaChoice R4182-001
- HumanaChoice R4182-003
HumanaChoice H5216-042 Availability
HumanaChoice H5216-042 is available in Abilene, Trent, Buffalo Gap, Ovalo, Merkel, Tuscola, Tye, Dyess AFB, Lawn, and all other areas of Taylor County.
This page was last updated on 10/14/2017.
Plan data on Medicare-Plans.net comes from CMS.gov and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.
This page is a brief summary, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly.
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