L3Harris Plan - H5216-805-249

4.5 out of 5 stars* for plan year 2024

$107.97

Monthly Premium

L3Harris Plan is a Medicare Advantage (Medicare Part C) plan offered by Humana Inc.

Plan ID: H5216-805-249

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

$107.97

Monthly Premium

South Dakota, Utah, Pennsylvania, Texas, Georgia, Louisiana, Iowa, Tennessee, Ohio, Colorado, and Wisconsin 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 South Dakota, Utah, Pennsylvania, Texas, Georgia, Louisiana, Iowa, Tennessee, Ohio, Colorado, and Wisconsin Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage	Details
Monthly plan premium	$107.97
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible	$0.00
Out-of-pocket maximum	$1,750.00
Initial drug coverage limit	$0.00
Catastrophic drug coverage limit	$8,000.00
Primary care doctor visit	In or Out of Network: 5% coinsurance
Specialty doctor visit	In or Out of Network: 5% coinsurance
Inpatient hospital care	In or Out of Network: $300 copay/admit
Urgent care	In or Out of Network: 5% coinsurance
Emergency room visit	In or Out of Network: 5% coinsurance. \|Waived if admitted within 24 hours.\|Worldwide Coverage: 20% coinsurance. $100 deductible per year, $25,000 Maximum Benefit per year or 60 consecutive days, whichever is reached first. Limited to emergency Medicare-covered services.
Ambulance transportation	In or Out of Network: 5% coinsurance per date of service. \|Limited to Medicare-covered transportation.

Health Care Services and Medical Supplies

L3Harris Plan covers a range of additional benefits. Learn more about L3Harris Plan benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage	Details
Chiropractic services	In or Out of Network: \|Medicare-covered Chiropractic Services: 5% coinsurance \|Routine Chiropractic Services: 20% coinsurance, 20 combined in- and out-of-network visit limit per plan year
Diabetes supplies, training, nutrition therapy and monitoring	Diabetes Self-Management Services\|In or Out of Network: $0 copayment\|Diabetes Supplies and Services\|In or Out of Network: $0 - 5% coinsurance
Durable medical equipment (DME)	In or Out of Network: 5% coinsurance
Diagnostic tests, lab and radiology services, and X-rays	Diagnostic Tests, Lab and Radiology Services, and X-Rays\|In or Out of Network: 5% coinsurance \|Medicare-Covered diagnostic procedures and tests\|In or Out of Network: 5% coinsurance\|Medicare-covered diagnostic radiology services (not including x-rays)\|In or Out of Network: 5% coinsurance \|Medicare-covered lab services\|In or Out of Network: 5% coinsurance \|Medicare-covered therapeutic radiology services\|In or Out of Network: 5% coinsurance \|Medicare-covered X-rays\|In or Out of Network: 5% coinsurance
Home health care	In or Out of Network: $0 copayment, excludes Personal Home Care
Mental health inpatient care	In or Out of Network: $300 copay/admit \|190 day lifetime limit in a psychiatric facility
Mental health outpatient care	In or Out of Network: 5% coinsurance
Outpatient services/surgery	Ambulatory Surgery Center\|In or Out of Network: 5% coinsurance\|Outpatient Services/Surgery\|In or Out of Network: 5% coinsurance
Outpatient substance abuse care	In or Out of Network: 5% coinsurance
Podiatry services	In or Out of Network: \|Medicare-covered podiatry services: 5% coinsurance\|Routine Podiatry Services: 20% coinsurance
Skilled Nursing Facility (SNF) care	In or Out of Network: \|$0 copay per day for days 1-20 \|$37 copay per day for days 21-100 \|20% of the cost per stay for days 101-120

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	In or Out of Network: 5% coinsurance \|Limited to Medicare-covered dental services.

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	Medicare-covered Eyewear\|In or Out of Network: 5% coinsurance for eyeglasses and contacts following cataract surgery\|Vision Services\|In or Out of Network: 5% coinsurance \|Limited to Medicare-covered vision services.

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: 5% coinsurance for Medicare-covered hearing services. \|$0 copayment for routine hearing exams up to 1 per year, up to $45 maximum benefit coverage. $600 combined in and out of network maximum benefit coverage amount for each hearing aid(s) (all types) up to 1 per ear every 3 years. \|Members must contact TruHearing to utilize Out of Network benefits.

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	Glaucoma Screening\|In or Out of Network: $0 copayment\|Preventive Services\|In or Out of Network: $0 copayment

When reviewing South Dakota, Utah, Pennsylvania, Texas, Georgia, Louisiana, Iowa, Tennessee, Ohio, Colorado, and Wisconsin 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 South Dakota, Utah, Pennsylvania, Texas, Georgia, Louisiana, Iowa, Tennessee, Ohio, Colorado, and Wisconsin 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.