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HumanaChoice SNP-DE H5525-046 (PPO D-SNP) - H5525-046-000
$0.00
Monthly Premium
HumanaChoice SNP-DE H5525-046 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5525-046-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0.00
Monthly Premium
Ohio Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.
Learn more about Ohio Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
Enrollment may be limited to certain times of the year. See why you may be able to enroll.
Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $0.00 |
| Out-of-pocket maximum | $9,350.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,000.00 |
| Primary care doctor visit | In-Network: Doctor Office Visit: Coinsurance for Primary Care Office Visit 0% or 20% |
| Specialty doctor visit | In-Network: Doctor Specialty Visit: Coinsurance for Physician Specialist Office Visit 0% or 20% |
| Inpatient hospital care | Out-of-Network: Acute Hospital Services: Copayment for Acute Hospital Services per Stay $0 or $2185 |
| Urgent care | Urgent Care: Coinsurance for Urgent Care 0% or 20% Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0 or $110 |
| Emergency room visit | Emergency Care: Copayment for Emergency Care $0 or $110 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $0 or $110 Copayment for Worldwide Emergency Transportation $0 or $110 |
| Ambulance transportation | Out-of-Network: Ambulance Services: Copayment for Medicare Covered Ambulance Services - Ground $0 or $305 Copayment for Medicare Covered Ambulance Services - Air $0 or $305 |
Health Care Services and Medical Supplies
HumanaChoice SNP-DE H5525-046 (PPO D-SNP) covers a range of additional benefits. Learn more about HumanaChoice SNP-DE H5525-046 (PPO D-SNP) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
| Coverage | Details |
|---|---|
| Chiropractic services | Out-of-Network: Medicare Covered Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 0% or 20% |
| Diabetes supplies, training, nutrition therapy and monitoring | In-Network: Diabetic Supplies and Services: Copayment for Medicare-covered Diabetic Supplies $0 or 0 Coinsurance for Medicare-covered Diabetic Supplies 0 or 20% Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0 |
| Durable medical equipment (DME) | Out-of-Network: Medicare Covered Durable Medical Equipment Services: Copayment for Medicare Covered Durable Medical Equipment $0 or 0 Coinsurance for Medicare Covered Durable Medical Equipment 0 or 20% 20% Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy20% DME - DME Prov20% DME - Pharmacy_ |
| Diagnostic tests, lab and radiology services, and X-rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 or 0 Coinsurance for Medicare-covered Diagnostic Procedures/Tests 0 or 20% Copayment for Medicare-covered Lab Services $0 or 0 Coinsurance for Medicare-covered Lab Services 0 or 20% Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services 20% OP Diag Proc & Tests - OPH20% OP Diag Proc & Tests - PCP20% OP Diag Proc & Tests - SPC20% OP Diag Proc & Tests - UCC20% Sleep Study (Fac Based) - OPH20% Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home_ Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0 or 200 to $325 Coinsurance for Medicare-covered Diagnostic Radiological Services 0 or 15% to 20% Coinsurance for Medicare-covered Therapeutic Radiological Services 0% or 20% Copayment for Medicare-covered X-Ray Services $0 or 50 Coinsurance for Medicare-covered X-Ray Services 0 or 20% |
| Home health care | Out-of-Network: Medicare Covered Home Health Services: Copayment for Medicare Covered Home Health $0 |
| Mental health inpatient care | Out-of-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital per Stay $0 or $2036 |
| Mental health outpatient care | In-Network: Outpatient Mental Health Services: Copayment for Medicare-covered Individual Sessions $0 or $45 Copayment for Medicare-covered Group Sessions $0 or $45 |
| Outpatient services/surgery | In-Network: Outpatient Hospital Services: Coinsurance for Medicare Covered Outpatient Hospital Services 0% or 20% Prior Authorization Required for Outpatient Hospital Services Outpatient Observation Services: Coinsurance for Medicare Covered Observation Services 0% or 20% Prior Authorization Required for Outpatient Observation Services Ambulatory Surgical Center Services: Coinsurance for Ambulatory Surgical Center Services 0% or 20% Prior Authorization Required for Ambulatory Surgical Center Services |
| Outpatient substance abuse care | Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Copayment for Medicare Covered Individual Sessions $0 or 45 Coinsurance for Medicare Covered Individual Sessions 0 or 20% Copayment for Medicare Covered Group Sessions $0 or 45 Coinsurance for Medicare Covered Group Sessions 0 or 20% 20% OP Substance Abuse Care - OPH$45 OP Substance Abuse Care - SPC_ |
| Over-the-counter items | Out-of-Network: Non-Medicare Covered Over-The-Counter (OTC) Items Services: Copayment for Non-Medicare Covered Over-The-Counter (OTC) Items $0
|
| Podiatry services | Out-of-Network: Medicare Covered Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 0% or 20% |
| Skilled Nursing Facility (SNF) care | 0 or $In-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $214 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services |
Dental Benefits
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Dental care | $0 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. $0 copayment for comprehensive oral evaluation or periodontal exam, scaling for moderate inflammation up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for emergency diagnostic exam up to 1 per year. $0 copayment for periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for amalgam and/or composite filling, necessary anesthesia with covered service up to unlimited per year. $1,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits.Out of Network$0 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. $0 copayment for comprehensive oral evaluation or periodontal exam, scaling for moderate inflammation up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for emergency diagnostic exam up to 1 per year. $0 copayment for periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for amalgam and/or composite filling, necessary anesthesia with covered service up to unlimited per year. $1,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
Vision Benefits
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage
| Coverage | Details |
|---|---|
| Vision care | Out-of-Network: Medicare Covered Eye Exams Services: Coinsurance for Medicare Covered Eye Exams 0% or 20% to 50% Coinsurance for Medicare Covered Eyewear 0% or 20% |
Hearing Benefits
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing care | Out-of-Network: Medicare Covered Hearing Exams Services: Coinsurance for Medicare Covered Hearing Exams 0% or 20% |
Preventive Services and Health/Wellness Education Programs
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | Out-of-Network: Medicare Covered Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $0 or 0 Coinsurance for Medicare Covered Medicare-covered Preventive Services 0 or 30% to 50% |
When reviewing Ohio Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of Ohio that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
| Links to plan documents |
Ohio Counties Served
- Adams
- Allen
- Ashland
- Ashtabula
- Athens
- Auglaize
- Belmont
- Brown
- Butler
- Carroll
- Champaign
- Clark
- Clermont
- Clinton
- Columbiana
- Coshocton
- Crawford
- Cuyahoga
- Darke
- Defiance
- Delaware
- Erie
- Fairfield
- Franklin
- Fulton
- Gallia
- Geauga
- Greene
- Guernsey
- Hamilton
- Hancock
- Hardin
- Harrison
- Henry
- Highland
- Holmes
- Jackson
- Jefferson
- Knox
- Lake
- Lawrence
- Licking
- Logan
- Lorain
- Lucas
- Madison
- Mahoning
- Marion
- Medina
- Meigs
- Miami
- Monroe
- Montgomery
- Morgan
- Morrow
- Muskingum
- Noble
- Ottawa
- Paulding
- Perry
- Pickaway
- Portage
- Preble
- Putnam
- Ross
- Sandusky
- Scioto
- Seneca
- Shelby
- Stark
- Summit
- Trumbull
- Tuscarawas
- Union
- Van Wert
- Vinton
- Warren
- Washington
- Wayne
- Williams
- Wood
- Wyandot
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.