2021 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | HumanaChoice H5216-052 (PPO) | ||||
Location: | Belmont, Ohio Click to see other locations | ||||
Plan ID: | H5216 - 052 - 0 Click to see other plans | ||||
Member Services: | |||||
— 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 |
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Email a copy of the HumanaChoice H5216-052 (PPO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $49.00 | ||||
Annual Rx Deductible: | $100 | ||||
Annual Rx Initial Coverage Limit (ICL): | $4,130 | ||||
Health Plan Type: | Local PPO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $5,500 | ||||
Additional Rx Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,451 drugs | Browse the HumanaChoice H5216-052 (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: | $7.00 | $17.00 | $47.00 | $100.00 | 31% |
• Number of Drugs per Tier: | 306 | 599 | 775 | 1081 | 690 |
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in Belmont, Ohio: | 290 members | ||||
Number of Members enrolled in this plan in (H5216 - 052): | 3,825 members | ||||
Plan’s Summary Star Rating: | 4 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 3 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. |
— Plan Health Benefits — |