4

4 out of 5 stars* for plan year 2024

Plan ID: H5216-009

What You Need to Know:

  • HumanaChoice H5216-009 (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 $70, 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 H5216-009 (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 $32.

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

$70

Monthly Premium

Medicare Plan Features
Monthly Premium: $70.00
Part C Premium: $37.90
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$70.00 $37.90 $32.10 $0 $32.10 $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: H5216-011
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 Isabella, Michigan: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
111 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 Isabella, Michigan: NULL
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
$37.90 $32.10 $0.00 $70.00
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
$39.90 $24.60 $62.50 $17.10 $55.00 $9.50 $47.40
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 $6.00 599 $15.00 788 $47.00 1084 $100.00 684 33%

Other Medicare Advantage Plans in Isabella, Michigan

Plan Name Type Premium MOOP Rx Deduct. Rating
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4
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5
BCN Advantage HMO-POS Classic (HMO-POS) (2023)Local HMO$3,800$0
5
BCN Advantage HMO-POS Prestige (HMO-POS) (2023)Local HMO$3,400$0
5
HumanaChoice H8087-001 (PPO) (2023)Local PPO$5,900$75
5
PriorityMedicare Select (PPO) (2023)Local PPO$3,500$0
5
HAP Senior Plus (HMO) (2023)Local HMO$5,000$0
4
PriorityMedicare Ideal (PPO) (2023)Local PPO$5,800$125
5
HAP Senior Plus Medical Only (HMO) (2023)Local HMO *$4,000$-
4
HAP Senior Plus Option 1 (HMO-POS) (2023)Local HMO$4,200$0
4
PriorityMedicare Edge (PPO) (2023)Local PPO$5,300$0
5
HAP Senior Plus Option 2 (HMO-POS) (2023)Local HMO$4,000$0
4
PriorityMedicare Vital (PPO) (2023)Local PPO$6,000$350
5
Medicare Plus Blue PPO Vitality (PPO) (2023)Local PPO$5,000$100
5
Humana Value Plus H8087-002 (PPO) (2023)Local PPO$7,550$260
5
HumanaChoice R3887-001 (Regional PPO) (2023)Regional PPO *$5,500$-
5
PriorityMedicare Value (HMO-POS) (2023)Local HMO$4,900$75
3
Medicare Plus Blue PPO Assure (PPO) (2023)Local PPO$3,425$0
5
HAP Senior Plus Option 4 (PPO) (2023)Local PPO$4,000$0
4
Medicare Plus Blue PPO Signature (PPO) (2023)Local PPO$4,700$0
5
HumanaChoice R3887-002 (Regional PPO) (2023)Regional PPO$5,300$380
5
HAP Senior Plus Option 3 (PPO) (2023)Local PPO$4,500$0
4
PriorityMedicare Key (HMO-POS) (2023)Local HMO$5,500$100
3
Medicare Plus Blue PPO Essential (PPO) (2023)Local PPO$6,000$100
5
HAP Senior Plus Option 1 (PPO) (2023)Local PPO$6,000$0
4
PriorityMedicare Merit (PPO) (2023)Local PPO$4,100$0
5
HAP Senior Plus Option 2 (PPO) (2023)Local PPO$5,000$0
4
PriorityMedicare (HMO-POS) (2023)Local HMO$4,500$0
3
BCN Advantage HMO-POS Elements (HMO-POS) (2023)Local HMO *$4,500$-
5
Medicare Advantage Plans by Humana
Humana Honor (PPO) (2023)Local PPO *$5,500$-
4
HumanaChoice H8087-001 (PPO) (2023)Local PPO$5,900$75
5
Humana Value Plus H8087-002 (PPO) (2023)Local PPO$7,550$260
5
HumanaChoice R3887-001 (Regional PPO) (2023)Regional PPO *$5,500$-
5
HumanaChoice R3887-002 (Regional PPO) (2023)Regional PPO$5,300$380
5

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