HumanaChoice H5216-175 (PPO) in Androscoggin, Maine (2023)
HumanaChoice H5216-175 (PPO) in Androscoggin County, Maine costs $0/mo. This affordable Regional PPO plan (H5216-175) is a top choice for those living in Androscoggin County with a $250 prescription deductible and out-of-pocket limits at $6,500. Learn more about Medicare Part C by AARP in Androscoggin County, Maine below.
UPDATED: Sep 21, 2023
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UPDATED: Sep 21, 2023Fact Checked
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4 out of 5 stars* for plan year 2024
Plan ID: H5216-175
What You Need to Know:
- HumanaChoice H5216-175 (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 $0, which does not include your monthly Medicare Part B premium.
- The annual deductible for this health plan is $250 (Tier 1, 2 and 3 excluded from the Deductible.).
- The plan includes an out-of-pocket maximum of $6,500 per year (in-network).
- HumanaChoice H5216-175 (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $250 (Tier 1, 2 and 3 excluded from the Deductible.).
- This plan's Part D Initial Coverage Limit is $0.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0
Monthly Premium
| Medicare Plan Features | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Monthly Premium: | $0 | ||||||||
| Part C Premium: | $0 | ||||||||
| Monthly Premium: | Part C Premium: | Part D Drug Premium: | Part D Supplemental Premium: | Total Part D Premium: | Drug Deductible: | Tiers with No Deductible: | |||
| $0 | $0 | $0 | $0 | $0 | $250.0 | 1.0 | |||
| Gap Coverage: | No | ||||||||
| Benchmark: | not below the regional benchmark | ||||||||
| Type of Medicare Health: | Enhanced Alternative | ||||||||
| Health Plan Type: | Local PPO | ||||||||
| Similar Plan: | H5216-176 | ||||||||
| 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): | $6,500 | ||||||||
| Annual Deductible: | $250 (Tier 1, 2 and 3 excluded from the Deductible.) | ||||||||
| Annual Initial Coverage Limit ICL: | $4,130 | ||||||||
| Number of Members enrolled in this plan in Androscoggin, Maine: | Plans Summary Star Rating: | Customer Service Rating: | Drug Cost Rating: | ||||||
| 330 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 Androscoggin, Maine: | 3,125 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 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| 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 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 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 | $2.00 | 599 | $9.00 | 788 | $47.00 | 1084 | $100.00 | 684 | 28% |