4

4 out of 5 stars* for plan year 2024

Plan ID: H5216-154

What You Need to Know:

  • HumanaChoice H5216-154 (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 $400 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $7,550 per year (in-network).
  • HumanaChoice H5216-154 (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $400 (Tier 1 and 2 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 $400.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H5216-157
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): $7,550
Annual Deductible: $400 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Gwinnett, Georgia: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
169 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: 3,250 drugs
Number of Members Enrolled in this Plan in Gwinnett, Georgia: 8,827 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)
222 $5.00 638 $15.00 717 $47.00 997 $100.00 676 25%

Other Medicare Advantage Plans in Gwinnett, Georgia

Plan Name Type Premium MOOP Rx Deduct. Rating
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Humana Care Extra (PPO) (2023)Local PPO$7,550$0
4
UnitedHealthcare Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$6,700$295
5
Anthem MediBlue Access (PPO) (2023)Local PPO$5,900$95
4
AARP Medicare Advantage Plus Plan 1 (HMO-POS) (2023)Local HMO$6,700$275
5
HumanaChoice R3392-002 (Regional PPO) (2023)Regional PPO$6,700$340
4
Anthem MediBlue Access Basic (PPO) (2023)Local PPO$6,700$150
4
HumanaChoice R3392-001 (Regional PPO) (2023)Regional PPO *$6,700$-
4
AARP Medicare Advantage Plus Plan 2 (HMO-POS) (2023)Local HMO$4,900$175
5
Anthem MediBlue Core (HMO) (2023)Local HMO *$7,550$-
5
HumanaChoice H5216-241 (PPO) (2023)Local PPO$7,550$445
4
Cigna True Choice Medicare (PPO) (2023)Local PPO$6,950$95
New plan - not yet rated.
Humana Gold Choice H8145-069 (PFFS) (2023)PFFS$-$340
4
Anthem MediBlue Essential (HMO) (2023)Local HMO$3,450$95
5
Aetna Medicare Essential Plan (PPO) (2023)Local PPO$6,900$195
5
Anthem MediBlue Plus (HMO) (2023)Local HMO$6,700$150
5
Aetna Medicare Value Plus Plan (PPO) (2023)Local PPO$7,550$195
5
CareSource Advantage (HMO) (2023)Local HMO$4,600$30
New plan - not yet rated.
UnitedHealthcare Medicare Advantage Patriot (Regional PPO (2023)Regional PPO *$6,700$-
5
Allwell Medicare (HMO) (2023)Local HMO$7,550$280
5
CareSource Advantage Zero Premium (HMO) (2023)Local HMO$6,700$100
New plan - not yet rated.
Allwell Medicare Premier (HMO) (2023)Local HMO$7,550$0
5
HumanaChoice H5216-157 (PPO) (2023)Local PPO *$6,700$-
4
Anthem MediBlue Extra (HMO) (2023)Local HMO$5,900$445
5
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) (2023)Local PPO$6,700$275
5
HumanaChoice H5216-203 (PPO) (2023)Local PPO$7,550$0
4
Cigna Preferred Medicare (HMO) (2023)Local HMO$6,200$0
4
WellCare Focus (HMO) (2023)Local HMO$3,450$0
5
Kaiser Permanente Senior Advantage Basic (HMO) (2023)Local HMO$6,400$0
5
WellCare Dividend (HMO) (2023)Local HMO$6,700$200
5
Aetna Medicare Select Plan (HMO) (2023)Local HMO$6,900$250
5
Aetna Medicare Plus Plan (PPO) (2023)Local PPO$7,550$400
New plan - not yet rated.
LiveHealthy: Clover Powered, Walmart Enhanced (PPO) (2023)Local PPO$7,550$0
4
Sonder Health Plans, Inc (HMO) (2023)Local HMO$5,900$0
New plan - not yet rated.
LiveHealthy LI: Clover Powered, Walmart Enhanced (PPO) (2023)Local PPO$7,550$445
4
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,900$-
New plan - not yet rated.
WellCare Flex Complete (PPO) (2023)Local PPO$2,500$0
5
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Humana Gold Plus H4141-015 (HMO) (2023)Local HMO$6,800$0
4
WellCare Premier (PPO) (2023)Local PPO$4,900$75
5
WellCare Patriot (HMO-POS) (2023)Local HMO *$3,400$-
5
HumanaChoice H5216-073 (PPO) (2023)Local PPO$6,700$360
4
WellCare Compass (HMO) (2023)Local HMO$3,450$445
5
WellCare Endurance (PPO) (2023)Local PPO$4,900$0
5
Humana Gold Plus H4141-017 (HMO) (2023)Local HMO$7,550$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Cigna Preferred GA Medicare (HMO) (2023)Local HMO$7,500$300
4
WellCare Value (HMO) (2023)Local HMO$3,450$0
5
WellCare Prime (PPO) (2023)Local PPO$5,100$0
5
Kaiser Permanente Senior Advantage Enhanced (HMO) (2023)Local HMO$4,500$0
5
Cigna Premier Medicare (HMO-POS) (2023)Local HMO$5,700$0
4
Medicare Advantage Plans by Humana
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Humana Care Extra (PPO) (2023)Local PPO$7,550$0
4
HumanaChoice R3392-002 (Regional PPO) (2023)Regional PPO$6,700$340
4
HumanaChoice R3392-001 (Regional PPO) (2023)Regional PPO *$6,700$-
4
HumanaChoice H5216-241 (PPO) (2023)Local PPO$7,550$445
4
Humana Gold Choice H8145-069 (PFFS) (2023)PFFS$-$340
4
HumanaChoice H5216-157 (PPO) (2023)Local PPO *$6,700$-
4
HumanaChoice H5216-203 (PPO) (2023)Local PPO$7,550$0
4
Humana Gold Plus H4141-015 (HMO) (2023)Local HMO$6,800$0
4
HumanaChoice H5216-073 (PPO) (2023)Local PPO$6,700$360
4
Humana Gold Plus H4141-017 (HMO) (2023)Local HMO$7,550$0
4

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