4

4 out of 5 stars* for plan year 2024

Plan ID: H5216-054

What You Need to Know:

  • HumanaChoice H5216-054 (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $47, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $5,900 per year (in-network).
  • HumanaChoice H5216-054 (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $39.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$47

Monthly Premium

Medicare Plan Features
Monthly Premium: $47.00
Part C Premium: $8.00
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$47.00 $8.00 $39.00 $0 $39.00 $0 0.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H5216-055
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $5,900
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Daviess, Indiana: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members 4 out of 5 Stars. 4 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,461 drugs
Number of Members Enrolled in this Plan in Daviess, Indiana: 4,153 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$8.00 $39.00 $0.00 $47.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$17.40 $31.60 $39.60 $24.20 $32.20 $16.80 $24.80
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
306 $7.00 599 $17.00 788 $47.00 1084 $100.00 684 33%

Other Medicare Advantage Plans in Daviess, Indiana

Plan Name Type Premium MOOP Rx Deduct. Rating
AARP Medicare Advantage Plan 1 (HMO-POS) (2023)Local HMO$4,900$125
5
Anthem MediBlue Access Plus (PPO) (2023)Local PPO$6,400$60
5
Anthem MediBlue Extra (HMO) (2023)Local HMO$6,700$445
4
Aetna Medicare Value (PPO) (2023)Local PPO$5,700$0
5
Anthem MediBlue Access Basic (Regional PPO) (2023)Regional PPO$6,400$100
5
Aetna Medicare Premier (PPO) (2023)Local PPO$4,800$0
5
Health Alliance Medicare HMO 20 Rx (HMO) (2023)Local HMO$4,000$0
4
Health Alliance Medicare HMO Basic Rx (HMO) (2023)Local HMO$6,700$0
4
Health Alliance Medicare HMO 40 Rx (HMO) (2023)Local HMO$4,700$0
4
Anthem MediBlue Access Preferred (PPO) (2023)Local PPO$4,900$125
5
Health Alliance Medicare POS Basic Rx (HMO-POS) (2023)Local HMO$6,700$0
4
Health Alliance Medicare POS 30 Rx (HMO-POS) (2023)Local HMO$5,500$0
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$4,500$50
5
Health Alliance Medicare POS 10 Rx (HMO-POS) (2023)Local HMO$4,500$0
4
Simplete Richland 1 (HMO) (2023)Local HMO$4,000$0
4
Anthem MediBlue Plus (HMO) (2023)Local HMO$4,400$0
4
AARP Medicare Advantage Choice Premier (PPO) (2023)Local PPO$7,550$445
5
HumanaChoice H5216-111 (PPO) (2023)Local PPO$4,900$100
4
HumanaChoice R0865-003 (Regional PPO) (2023)Regional PPO$6,700$195
4
HumanaChoice H5216-192 (PPO) (2023)Local PPO$7,550$250
4
Allwell Medicare Complement (HMO) (2023)Local HMO$5,500$445
New plan - not yet rated.
Humana Value Plus H5216-193 (PPO) (2023)Local PPO$7,550$260
4
HumanaChoice R0865-001 (Regional PPO) (2023)Regional PPO *$6,200$-
4
IU Health Plans Medicare Select Plus (HMO) (2023)Local HMO$4,950$200
4
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$5,500$-
5
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Health Alliance Medicare POS Basic (HMO-POS) (2023)Local HMO *$6,700$-
4
Health Alliance Medicare HMO Basic (HMO) (2023)Local HMO *$6,700$-
4
Aetna Medicare Eagle (PPO) (2023)Local PPO *$5,900$-
5
Medicare Advantage Plans by Humana
HumanaChoice H5216-111 (PPO) (2023)Local PPO$4,900$100
4
HumanaChoice R0865-003 (Regional PPO) (2023)Regional PPO$6,700$195
4
HumanaChoice H5216-192 (PPO) (2023)Local PPO$7,550$250
4
Humana Value Plus H5216-193 (PPO) (2023)Local PPO$7,550$260
4
HumanaChoice R0865-001 (Regional PPO) (2023)Regional PPO *$6,200$-
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4

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