2017 Medicare Advantage Plan Details | |||||
---|---|---|---|---|---|
Medicare Plan Name: | HumanaChoice H6609-106 (PPO) | ||||
Location: | Leake, Mississippi Click to see other locations | ||||
Plan ID: | H6609 - 106 - 0 Click to see other plans | ||||
Member Services: | 1-800-457-4708 TTY users 711 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
||||
Email a copy of the HumanaChoice H6609-106 (PPO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $53.00 (see Plan Premium Details below) | ||||
Annual Rx Deductible: | $400 (Tier 1, 2 and 3 excluded from the Deductible.) | ||||
Annual Rx Initial Coverage Limit (ICL): | $3,700 | ||||
Health Plan Type: | Local PPO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $6,700 | ||||
Additional Rx Gap Coverage? | Yes, some additional gap coverage. | ||||
Total Number of Formulary Drugs: | 3,962 drugs | Browse the HumanaChoice H6609-106 (PPO) Formulary | |||
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $5.00 | $15.00 | $47.00 | $99.00 | 25% |
• Number of Drugs per Tier: | 253 | 678 | 757 | 1674 | 600 |
Plan's Pharmacy Search: | https://www.humana.com/pharmacy/medicare/ | ||||
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in Mississippi: | 3,330 members | ||||
Number of Members enrolled in this plan in (H6609 - 106): | 3,932 members | ||||
Plan’s Summary Star Rating: | 3.5 out of 5 Stars. | ||||
• Customer Service Rating: | 2 out of 5 Stars. | ||||
• Member Experience Rating: | 4 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part C Premium | Part D Basic Premium | Part D Supplemental Premium | |
$53.00 | $27.80 | $25.20 | $0.00 | ||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $0.00 | $0.00 | $0.00 | $0.00 | |
Total Monthly Premium with LIS (Parts C & D): | $27.80 | $27.80 | $27.80 | $27.80 | |
— Plan Health Benefits — | |||||
** General Plan Information ** | |||||
Choice of Doctors?: Any Doctor | |||||
** Cost ** | |||||
Monthly Health Plan Premium: $27.80 | |||||
Monthly Drug Plan Premium: $25.20 | |||||
Health Plan Deductible: $1,000 annual deductible | |||||
Other Health Plan Deductibles?: No | |||||
Maximum Out-of-Pocket Enrollee Responsibility (does not include prescription drugs)
:
| |||||
** Extra Benefits ** | |||||
Prescription Drugs Covered?: Yes | |||||
Optional Supplemental Benefits?: Yes | |||||
** Outpatient Care and Services ** | |||||
Ambulance:
| |||||
Doctor's office visits:
| |||||
Durable medical equipment (wheelchairs, oxygen, etc.):
| |||||
Emergency care: $75 per visit (always covered) | |||||
Home health care:
| |||||
Mental health care:
| |||||
Outpatient hospital:
| |||||
Renal dialysis:
| |||||
** Inpatient Care ** | |||||
Inpatient hospital care:
| |||||
Optional Supplemental Benefits?: Yes | |||||
Skilled Nursing Facility (SNF):
| |||||
Prescription Drugs Covered?: Yes | |||||
** Additional Benefits ** | |||||
Optional Supplemental Benefits?: Yes |