HumanaChoice H5216-107 (PPO) 2025 Plan Details for Rowan County, Kentucky Residents
HumanaChoice H5216-107 (PPO) 2025 Plan Details for Rowan County, Kentucky Residents
Choosing the right Medicare Advantage plan in Rowan County is crucial for your healthcare needs in 2025. With HumanaChoice H5216-107 (PPO) as one of the options, you can compare it side-by-side with other available plans to find the best fit for you. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
- Doctor Visits
- Foot Care
- Chiropractic
- Urgent & Emergency
- Mental Health
- Rehab Services
- Equipment & Supplies
- Diag, Lab, Imaging
- Part B Drugs
- Dental
- Hearing Aids
- Vision
- Prescriptions
HumanaChoice H5216-107 Overview
| Plan ID H5216-107-0 Overview | |
|---|---|
| Health Plan ID: | H5216-107-0 |
| Medicare Advantage Plan Type: | PPO |
| Plan Year: | 2025 |
| Monthly Premium: | $121.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $6,750.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $300.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Rowan County, KY |
| Insured By: | Humana |
| We're Here to Help You Enroll |
|---|
Out-of-Pocket Expenses
HumanaChoice H5216-107 has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5216-107-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $10 Copay |
| Specialist: | $50 Copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $125 Copay |
| Urgent care: | $55 Copay |
| Ground ambulance: | $315 Copay |
| Inpatient hospital care: | $900.00 per stay |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $214.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $50 Copay Prior Authorization Required |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $15 Copay Prior Authorization Required |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $50 Copay |
| Outpatient group therapy: | $50 Copay |
| Inpatient psychiatric hospital care: | $900.00 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $40 Copay Prior Authorization Required |
| Occupational therapy: | $40 Copay Prior Authorization Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $325 Copay Prior Authorization Required |
| Lab services: | $55 Copay Prior Authorization Required |
| Outpatient x-rays: | $130 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $90 Copay Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | $50 Copay Prior Authorization Required |
| Oral exam | $0 Copay |
| Dental x-rays | $0 Copay |
| Cleaning | $0 Copay |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay Prior Authorization Required, Limitations Apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay Prior Authorization Required |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 to $50 Copay |
| Routine eye exam (in-network) | $0 Copay Prior Authorization Required, 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $100.00 Every year |
Certain preventive services are covered 100% by HumanaChoice H5216-107 as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Part D Plan Premium
While the prescription drug plan (Part D) premium is included in the overall plan cost, some plans may have additional costs or provide assistance through the Low-Income Subsidy (LIS) program. Also known as Extra Help, LIS is a Social Security program that assists individuals with limited income and resources in reducing or eliminating Part D expenses. It is not part of a Medicare Advantage plan.
The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $71.30 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $71.30 |
| Low Income Premium Subsidy: | $49.58 |
| Low Income Premium Subsidy CMS Pays: | $49.60 |
| Low Income Subsidy Premium: | $21.70 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
This plan's Part D deductible is $300.00 per year. You'll pay this amount at the pharmacy before Humana begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the monthly premium and deductible, HumanaChoice H5216-107 may have costs when you pick up your prescriptions. The following table describes pharmacy out-of-pocket costs by drug tier.
| Drug Tier | Retail | Mail Order | |
|---|---|---|---|
| Preferred Generic* | $5.00 | $10.00 | |
| Generic* | $15.00 | $20.00 | |
| Preferred Brand | $47.00 | $47.00 | |
| Non-Preferred Drug | 50.00% | 50.00% | |
| Specialty Tier | 29.00% | 29.00% | |
| *Deductible does not apply. | |||
Understanding CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Am I Eligible for HumanaChoice H5216-107 ?
You are eligible to enroll in HumanaChoice H5216-107 if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for HumanaChoice H5216-107 and take advantage of its full range of benefits.
Enrollment Periods for HumanaChoice H5216-107
Knowing when you can enroll in HumanaChoice H5216-107 is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Enroll in HumanaChoice H5216-107
Getting started with HumanaChoice H5216-107 is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with HumanaChoice H5216-107 . The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Contact Humana
| Website: | Humana Plan Page |
|---|---|
| Providers: | Humana Providers Page |
| Formulary: | Humana Formulary Page |
| Pharmacy: | Humana Pharmacy Page |
| New Member Health Plan Help: | (800)833-2364 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)833-2364 |
| New Member Part D TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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