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A message from Bruce Broussard, Humana President and CEO, and David Cordani, Cigna Corporation President and CEO. Cigna Steps Up to Help Relieve Financial Stress During Pandemic Improving the health, well-being and peace of mind of those we serve. Humana Medicare plans are recommended by USAA Beneficiaries can expect simple and secure enrollment both online and over the phone Humana Inc. (NYSE: HUM) today announced details of its 2021 Medicare product offerings, including Medicare Advantage and Prescription Drug Plans that are built with the benefits and options people eligible for Medicare need most.
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HumanaChoice Florida H5216-072 (PPO) H5216-072 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Humana available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The HumanaChoice Florida H5216-072 (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $4,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,900 out of pocket. This can be a extremely nice safety net.
HumanaChoice Florida H5216-072 (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 HumanaChoice Florida H5216-072 (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 Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2021 Humana Medicare Advantage Plan Costs
| Name: |
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| Plan ID: | H5216-072 |
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| Provider: | Humana |
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| Year: | 2021 |
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| Type: | Local PPO |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: | $0 |
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| MOOP: | $4,900 |
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| Part D (Drug) Premium: | $0 |
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| Part D Supplemental Premium | $0 |
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| Total Part D Premium: | $0 |
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| Drug Deductible: | $150.0 |
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| Tiers with No Deductible: | 1 |
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| Gap Coverage: | No |
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| Benchmark: | not below the regional benchmark |
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| Type of Medicare Health: | Enhanced Alternative |
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| Drug Benefit Type: | Enhanced |
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| Similar Plan: | H5216-073 |
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HumanaChoice Florida H5216-072 (PPO) Part-C Premium
Humana plan charges a $0 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.
H5216-072 Part-D Deductible and Premium
HumanaChoice Florida H5216-072 (PPO) has a monthly drug premium of $0 and a $150.0 drug deductible. This Humana plan offers a $0 Part D Basic Premium that is not 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 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 $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Humana Gap Coverage
In 2021 once you and your plan provider have spent $4130 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.
H5216-072 Formulary or Drug Coverage
HumanaChoice Florida H5216-072 (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.
2021 HumanaChoice Florida H5216-072 (PPO) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | Not covered |
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| Endodontics | Not covered |
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| Extractions | Not covered |
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| Non-routine services | Not covered |
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| Periodontics | 50% coinsurance (Out-of-Network) |
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| Periodontics | 0% coinsurance |
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| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
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| Restorative services | 50% coinsurance (Out-of-Network) |
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| Restorative services | 0% coinsurance |
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Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $40-250 copay or 20% coinsurance |
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| Diagnostic radiology services (e.g., MRI) | $65 copay or 50% coinsurance (Out-of-Network) |
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| Diagnostic tests and procedures | $0-65 copay or 50% coinsurance (Out-of-Network) |
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| Diagnostic tests and procedures | $0-200 copay or 20% coinsurance |
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| Lab services | $0-15 copay or 20% coinsurance |
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| Lab services | $65 copay or 50% coinsurance (Out-of-Network) |
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| Outpatient x-rays | $65 copay or 50% coinsurance (Out-of-Network) |
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| Outpatient x-rays | $5-40 copay or 20% coinsurance |
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Doctor Visits
| Primary | $65 copay per visit (Out-of-Network) |
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| Primary | $5 copay per visit |
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| Specialist | $65 copay per visit (Out-of-Network) |
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| Specialist | $40 copay per visit |
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Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $5-65 copay per visit (always covered) |
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Foot Care (podiatry services)
| Foot exams and treatment | $65 copay (Out-of-Network) |
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| Foot exams and treatment | $40 copay |
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| Routine foot care | Not covered |
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Ground Ambulance
| $240 copay |
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| $240 copay (Out-of-Network) |
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Hearing
| Fitting/evaluation | 25% coinsurance (Out-of-Network) |
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| Fitting/evaluation | $0 copay |
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| Hearing aids | 25% coinsurance (Out-of-Network) |
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| Hearing aids | $0 copay |
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| Hearing exam | $65 copay (Out-of-Network) |
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| Hearing exam | $40 copay |
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Inpatient Hospital Coverage
What Is Medicare Copay For 2020
$343 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond |
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$495 per day for days 1 through 27
$0 per day for days 28 through 90 (Out-of-Network) |
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Medical Equipment/Supplies
| Diabetes supplies | $0 copay or 20% coinsurance per item |
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| Diabetes supplies | 50% coinsurance per item (Out-of-Network) |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 30% coinsurance per item (Out-of-Network) |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 25% coinsurance per item (Out-of-Network) |
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Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
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| Chemotherapy | 20-50% coinsurance (Out-of-Network) |
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| Other Part B drugs | 20-50% coinsurance (Out-of-Network) |
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| Other Part B drugs | 20% coinsurance |
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Mental Health Services
| Inpatient hospital - psychiatric | $495 per day for days 1 through 27
$0 per day for days 28 through 90 (Out-of-Network) |
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| Inpatient hospital - psychiatric | $343 per day for days 1 through 4
$0 per day for days 5 through 90 |
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| Outpatient group therapy visit | $40 copay |
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| Outpatient group therapy visit | $65 copay (Out-of-Network) |
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| Outpatient group therapy visit with a psychiatrist | $40 copay |
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| Outpatient group therapy visit with a psychiatrist | $65 copay (Out-of-Network) |
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| Outpatient individual therapy visit | $40 copay |
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| Outpatient individual therapy visit | $65 copay (Out-of-Network) |
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| Outpatient individual therapy visit with a psychiatrist | $40 copay |
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| Outpatient individual therapy visit with a psychiatrist | $65 copay (Out-of-Network) |
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MOOP
$10,000 In and Out-of-network
$4,900 In-network |
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Option
Optional supplemental benefits
Outpatient Hospital Coverage
| $40-250 copay or 20% coinsurance per visit |
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| $65 copay or 50% coinsurance per visit (Out-of-Network) |
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Preventive Care
| $0 copay |
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| $0 copay or 50% coinsurance (Out-of-Network) |
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Preventive Dental
| Cleaning | $0 copay |
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| Cleaning | 50% coinsurance (Out-of-Network) |
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| Dental x-ray(s) | $0 copay |
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| Dental x-ray(s) | 50% coinsurance (Out-of-Network) |
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| Fluoride treatment | Not covered |
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| Oral exam | 50% coinsurance (Out-of-Network) |
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| Oral exam | $0 copay |
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Rehabilitation Services
| Occupational therapy visit | $10-40 copay |
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| Occupational therapy visit | $65 copay or 50% coinsurance (Out-of-Network) |
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| Physical therapy and speech and language therapy visit | $10-40 copay |
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| Physical therapy and speech and language therapy visit | $65 copay or 50% coinsurance (Out-of-Network) |
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Skilled Nursing Facility
$250 per day for days 1 through 58
$0 per day for days 59 through 100 (Out-of-Network) |
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$0 per day for days 1 through 20
$160 per day for days 21 through 100 |
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Transportation
Vision
| Contact lenses | $0 copay |
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| Contact lenses | $0 copay (Out-of-Network) |
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| Eyeglass frames | Not covered |
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| Eyeglass lenses | Not covered |
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| Eyeglasses (frames and lenses) | $0 copay |
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| Eyeglasses (frames and lenses) | $0 copay (Out-of-Network) |
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| Other | Not covered |
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| Routine eye exam | $0 copay |
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| Routine eye exam | $0 copay (Out-of-Network) |
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| Upgrades | Not covered |
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Wellness Programs (e.g. fitness nursing hotline)
Reviews for HumanaChoice Florida H5216-072 (PPO) H5216
| 2019 Overall Rating |
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| Part C Summary Rating |
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| Part D Summary Rating |
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| Staying Healthy: Screenings, Tests, Vaccines |
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| Managing Chronic (Long Term) Conditions |
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| Member Experience with Health Plan |
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| Complaints and Changes in Plans Performance |
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| Health Plan Customer Service |
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| Drug Plan Customer Service |
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| Complaints and Changes in the Drug Plan |
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| Member Experience with the Drug Plan |
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| Drug Safety and Accuracy of Drug Pricing |
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Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
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| Breast Cancer Screening |
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| Colorectal Cancer Screening |
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| Annual Flu Vaccine |
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| Improving Physical |
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| Improving Mental Health |
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| Monitoring Physical Activity |
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| Adult BMI Assessment |
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Managing Chronic And Long Term Care for Older Adults
| Total Rating |
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| SNP Care Management |
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| Medication Review |
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| Functional Status Assessment |
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| Pain Screening |
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| Osteoporosis Management |
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| Diabetes Care - Eye Exam |
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| Diabetes Care - Kidney Disease |
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| Diabetes Care - Blood Sugar |
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| Rheumatoid Arthritis |
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| Reducing Risk of Falling |
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| Improving Bladder Control |
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| Medication Reconciliation |
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| Statin Therapy |
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Member Experience with Health Plan
| Total Experience Rating |
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| Getting Needed Care |
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| Customer Service |
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| Health Care Quality |
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| Rating of Health Plan |
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| Care Coordination |
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Member Complaints and Changes in HumanaChoice Florida H5216-072 (PPO) Plans Performance
| Total Rating |
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| Complaints about Health Plan |
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| Members Leaving the Plan |
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| Health Plan Quality Improvement |
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| Timely Decisions About Appeals |
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Humana Medicare Coinsurance
Health Plan Customer Service Rating for HumanaChoice Florida H5216-072 (PPO)
| Total Customer Service Rating |
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| Reviewing Appeals Decisions |
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| Call Center, TTY, Foreign Language |
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HumanaChoice Florida H5216-072 (PPO) Drug Plan Customer Service Ratings
| Total Rating |
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| Call Center, TTY, Foreign Language |
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| Appeals Auto |
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| Appeals Upheld |
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Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
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| Complaints about the Drug Plan |
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| Members Choosing to Leave the Plan |
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| Drug Plan Quality Improvement |
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Member Experience with the Drug Plan
| Total Rating |
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| Rating of Drug Plan |
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| Getting Needed Prescription Drugs |
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Drug Safety and Accuracy of Drug Pricing
| Total Rating |
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| MPF Price Accuracy |
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| Drug Adherence for Diabetes Medications |
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| Drug Adherence for Hypertension (RAS antagonists) |
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| Drug Adherence for Cholesterol (Statins) |
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| MTM Program Completion Rate for CMR |
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| Statin with Diabetes |
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Humana Medicare Copays For Tiers
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Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for HumanaChoice Florida H5216-072 (PPO)
(Click county to compare all available Advantage plans)
Humana Co Pays By State
| State: | Florida
|
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| County: | Charlotte,Citrus,Collier,DeSoto,Hardee,
Hendry,Hernando,Highlands,Hillsborough,
Lee,Manatee,Orange,Osceola,
Pasco,Pinellas,Polk,Sarasota,
Seminole, |
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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, 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 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.