4

4 out of 5 stars* for plan year 2024

Plan ID: H5216-120

What You Need to Know:

  • HumanaChoice H5216-120 (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 $127, 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 $6,700 per year (in-network).
  • HumanaChoice H5216-120 (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 $41.

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

$127

Monthly Premium

Medicare Plan Features
Monthly Premium: $127.00
Part C Premium: $86.40
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$127.00 $86.40 $40.60 $0 $40.60 $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: H5216-124
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): $6,700
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Westmoreland, Pennsylvania: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 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 Westmoreland, Pennsylvania: 912 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
$86.40 $40.60 $0.00 $127.00
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
$89.50 $31.20 $117.60 $21.90 $108.30 $12.50 $98.90
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 $5.00 599 $15.00 788 $47.00 1084 $97.00 684 33%

Other Medicare Advantage Plans in Westmoreland, Pennsylvania

Plan Name Type Premium MOOP Rx Deduct. Rating
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HumanaChoice R0923-001 (Regional PPO) (2023)Regional PPO *$4,900$-
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HumanaChoice H5525-038 (PPO) (2023)Local PPO$6,700$0
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Aetna Medicare Advantra Silver (PPO) (2023)Local PPO$7,550$0
5
HumanaChoice R0923-002 (Regional PPO) (2023)Regional PPO$6,700$0
3
UPMC for Life PPO High Deductible with Rx (PPO) (2023)Local PPO$7,550$0
3
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Aetna Medicare Advantra Excela Prime (HMO) (2023)Local HMO$7,550$0
5
Aetna Medicare Gold Plan (PPO) (2023)Local PPO$7,550$0
5
Aetna Medicare Value (PPO) (2023)Local PPO$7,550$0
5
Community Blue Medicare HMO Signature (HMO) (2023)Local HMO$7,550$0
4
Aetna Medicare Advantra Gold (HMO) (2023)Local HMO$4,900$0
5
Security Blue HMO-POS ValueRx (HMO-POS) (2023)Local HMO$5,500$0
4
Aetna Medicare Advantra Silver (HMO) (2023)Local HMO$7,550$0
5
Community Blue Medicare HMO Prestige (HMO) (2023)Local HMO$6,700$0
4
HumanaChoice H5216-116 (PPO) (2023)Local PPO *$3,900$-
4
Humana Value Plus H5216-117 (PPO) (2023)Local PPO$6,700$420
4
Security Blue HMO-POS Basic (HMO-POS) (2023)Local HMO *$5,900$-
4
Freedom Blue PPO ValueRx (PPO) (2023)Local PPO$5,500$0
4
UPMC for Life HMO Rx Enhanced (HMO) (2023)Local HMO$7,550$0
4
Freedom Blue PPO Classic (PPO) (2023)Local PPO$4,500$0
4
Security Blue HMO-POS Standard (HMO-POS) (2023)Local HMO$5,000$0
4
Aetna Medicare Advantra Eagle (HMO) (2023)Local HMO *$4,000$-
5
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$5,500$-
5
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Allwell Medicare Boost (HMO) (2023)Local HMO$7,550$0
4
Security Blue HMO-POS Deluxe (HMO-POS) (2023)Local HMO$4,500$0
4
UPMC for Life HMO Rx (HMO) (2023)Local HMO$7,550$0
4
Complete Blue PPO Distinct (PPO) (2023)Local PPO$6,500$0
4
UPMC for Life HMO Deductible with Rx (HMO) (2023)Local HMO$7,550$0
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$4,900$0
New plan - not yet rated.
Allwell Medicare (HMO) (2023)Local HMO$6,700$0
4
Aetna Medicare Silver (HMO) (2023)Local HMO$7,550$0
5
UPMC for Life HMO Rx Choice (HMO) (2023)Local HMO$7,550$0
4
UPMC for Life HMO No Rx (HMO) (2023)Local HMO *$7,550$-
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Allwell Medicare Simple (HMO) (2023)Local HMO *$3,450$-
4
Freedom Blue PPO Select (PPO) (2023)Local PPO$5,000$0
4
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$6,700$0
5
UPMC for Life HMO Premier Rx (HMO) (2023)Local HMO$7,550$0
4
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$5,500$0
5
Allwell Medicare Complement (HMO) (2023)Local HMO$7,550$445
4
Medicare Advantage Plans by Humana
HumanaChoice R0923-001 (Regional PPO) (2023)Regional PPO *$4,900$-
3
Humana Gold Plus H6622-054 (HMO) (2023)Local HMO$6,700$0
4
HumanaChoice H5525-017 (PPO) (2023)Local PPO$5,900$0
4
HumanaChoice H5525-038 (PPO) (2023)Local PPO$6,700$0
4
HumanaChoice R0923-002 (Regional PPO) (2023)Regional PPO$6,700$0
3
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
HumanaChoice H5216-116 (PPO) (2023)Local PPO *$3,900$-
4
Humana Value Plus H5216-117 (PPO) (2023)Local PPO$6,700$420
4

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