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Medicare Plans
Iowa
Plymouth County
Medicare Plans
Iowa
Plymouth County
Thursday, November 21, 2019
HumanaChoice H5868-004 (PPO)
(H5868-004)
by Humana Insurance Company - Plymouth County, IA
Contact Information
Humana Insurance Company
500 West Main Street
Louisville, KY 40202
Phone: 1-800-457-4708
Toll free: 1-800-457-4708
Website
http://www.humana-medicare.com
Pharmacy
http://www.humana.com/Medicare/medicare_prescription_drugs
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Plan details
| Plan Rating | 3.5 out of 5 stars |
| Premium and Other Important Information | $0.00 monthly plan premium in addition to your monthly Medicare Part B premium. |
| Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. | |
| "Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept ""assignment"" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept Medicare ""assignment "" your coinsurance can be based on the Medicare-approved amount plus an additional amount up to a higher Medicare ""limiting charge."" If you are a member of a plan that charges a copay for out-of-network physician services the higher Medicare ""limiting charge"" does not apply. See the publications Medicare You or Your Medicare Benefits available on www.medicare.gov for a full listing of benefits under Original Medicare as well as for explanations of the rules related to ""assignment"" and ""limiting charges"" that apply by benefit type. To find out if physicians and DME suppliers accept assignment or participate in Medicare visit www.medicare.gov/physician or www.medicare.gov/supplier. You can also call 1-800-MEDICARE or ask your physician provider or supplier if they accept assignment." | |
| $4 000 out-of-pocket limit for Medicare-covered services. | |
| $500 annual deductible. Contact the plan for services that apply. | |
| $6 000 out-of-pocket limit for Medicare-covered services. | |
| Doctor and Hospital Choice | No referral required for network doctors specialists and hospitals. |
| You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits. | |
| Plan covers you when you travel in the U.S. | |
| Inpatient Hospital Care | No limit to the number of days covered by the plan each hospital stay. |
| For Medicare-covered hospital stays: | |
| Days 1 - 7: $250 copay per day | |
| Days 8 - 90: $0 copay per day | |
| $0 copay for each additional hospital day. | |
| Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital. | |
| 30% of the cost for each hospital stay. | |
| Inpatient Mental Health Care | You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital. |
| For Medicare-covered hospital stays: | |
| Days 1 - 7: $200 copay per day | |
| Days 8 - 90: $0 copay per day | |
| Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital. | |
| 30% of the cost for each hospital stay. | |
| Skilled Nursing Facility (SNF) | Authorization rules may apply. |
| Plan covers up to 100 days each benefit period | |
| No prior hospital stay is required. | |
| For SNF stays: | |
| Days 1 - 20: $0 copay per day | |
| Days 21 - 100: $125 copay per day | |
| 30% of the cost for each SNF stay. | |
| Home Health Care | Authorization rules may apply. |
| $0 copay for Medicare-covered home health visits | |
| 30% of the cost for home health visits | |
| Hospice | You must get care from a Medicare-certified hospice. Your plan will pay for a consultative visit before you select hospice. |
| Doctor Office Visits | $10 copay for each primary care doctor visit for Medicare-covered benefits. |
| $30 copay for each in-area network urgent care Medicare-covered visit | |
| $30 copay for each specialist visit for Medicare-covered benefits. | |
| $35 copay for each primary care doctor visit | |
| $35 copay for each specialist visit | |
| Chiropractic Services | Authorization rules may apply. |
| $10 copay for each Medicare-covered visit | |
| Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers. | |
| $35 copay for chiropractic benefits. | |
| Podiatry Services | Authorization rules may apply. |
| $30 copay for each Medicare-covered visit | |
| Medicare-covered podiatry benefits are for medically-necessary foot care. | |
| $35 copay for podiatry benefits. | |
| Outpatient Mental Health Care | Authorization rules may apply. |
| $30 copay for each Medicare-covered individual therapy visit | |
| $30 copay for each Medicare-covered group therapy visit | |
| $30 copay for each Medicare-covered individual therapy visit with a psychiatrist | |
| $30 copay for each Medicare-covered group therapy visit with a psychiatrist | |
| $30 copay for Medicare-covered partial hospitalization program services | |
| $35 copay for Mental Health benefits with a psychiatrist | |
| $35 copay for Mental Health benefits | |
| 30% of the cost for partial hospitalization program services | |
| Outpatient Substance Abuse Care | Authorization rules may apply. |
| $50 copay for Medicare-covered individual visits | |
| $50 copay for Medicare-covered group visits | |
| 30% of the cost for outpatient substance abuse benefits. | |
| Outpatient Services/Surgery | Authorization rules may apply. |
| $250 copay for each Medicare-covered ambulatory surgical center visit | |
| $50 to $250 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit | |
| 30% of the cost for outpatient hospital facility benefits. | |
| 30% of the cost for ambulatory surgical center benefits. | |
| Ambulance Services | Authorization rules may apply. |
| $100 copay for Medicare-covered ambulance benefits. | |
| $100 copay for ambulance benefits. | |
| Emergency Care | $65 copay for Medicare-covered emergency room visits |
| Worldwide coverage. | |
| If you are admitted to the hospital within 24-hour(s) for the same condition you pay $0 for the emergency room visit. | |
| Urgently Needed Care | $35 copay for Medicare-covered urgently-needed-care visits |
| Outpatient Rehabilitation Services | Authorization rules may apply. |
| $50 copay for Medicare-covered Occupational Therapy visits | |
| $50 copay for Medicare-covered Physical and/or Speech and Language Therapy visits | |
| $35 [or 30% of the cost] for Physical and/or Speech and Language Therapy visits | |
| $35 [or 30% of the cost] for Occupational Therapy benefits. | |
| Durable Medical Equipment | Authorization rules may apply. |
| 20% of the cost for Medicare-covered items | |
| 30% of the cost for durable medical equipment | |
| Prosthetic Devices | Authorization rules may apply. |
| 20% of the cost for Medicare-covered items | |
| 30% of the cost for prosthetic devices. | |
| Diabetes Programs and Supplies | Authorization rules may apply. |
| $0 copay for Diabetes self-management training | |
| 0% to 20% of the cost for Diabetes monitoring supplies | |
| $10 copay for Therapeutic shoes or inserts | |
| $35 copay [or 30% of the cost] for Diabetes self-management training | |
| 30% of the cost for Diabetes monitoring supplies | |
| 30% of the cost for Therapeutic shoes or inserts | |
| Diagnostic Tests X-Rays Lab Services and Radiology Services | Authorization rules may apply. |
| $0 to $50 copay for Medicare-covered lab services | |
| $0 to $50 copay for Medicare-covered diagnostic procedures and tests | |
| $10 to $50 copay for Medicare-covered X-rays | |
| $10 to $50 copay for Medicare-covered diagnostic radiology services (not including X-rays) | |
| $30 to $50 copay for Medicare-covered therapeutic radiology services | |
| $35 copay [or 30% of the cost] for therapeutic radiology services | |
| $35 copay [or 30% of the cost] for outpatient X-rays | |
| $35 copay [or 30% of the cost] for diagnostic radiology services | |
| $35 copay [or 30% of the cost] for diagnostic procedures tests and lab services | |
| Cardiac and Pulmonary Rehabilitation Services | Authorization rules may apply. |
| $30 to $50 copay for Medicare-covered Cardiac Rehabilitation Services | |
| $30 to $50 copay for Medicare-covered Intensive Cardiac Rehabilitation Services | |
| $30 to $50 copay for Medicare-covered Pulmonary Rehabilitation Services | |
| $35 copay [or 30% of the cost] for Cardiac Rehabilitation Services | |
| $35 copay [or 30% of the cost] for Intensive Cardiac Rehabilitation Services | |
| $35 copay [or 30% of the cost] for Pulmonary Rehabilitation Services | |
| Preventive Services and Wellness/Education Programs | $0 copay for all preventive services covered under Original Medicare at zero cost sharing: |
| HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy. Please contact plan for details. | |
| The plan covers the following supplemental education/wellness programs: | |
| $35 copay [or 30% of the cost] for Medicare-covered preventive services | |
| 50% of the cost for supplemental education/wellness programs | |
| Kidney Disease and Conditions | Authorization rules may apply. |
| 0% to 20% of the cost for renal dialysis | |
| $0 copay for kidney disease education services | |
| $35 copay for kidney disease education services | |
| 0% to 20% of the cost for renal dialysis | |
| Outpatient Prescription Drugs | Most drugs not covered. |
| 0% to 20% of the cost for Part B-covered drugs (not including Part B-covered chemotherapy drugs). | |
| 20% of the cost for Part B-covered chemotherapy drugs. | |
| 0% to 30% of the cost for Part B drugs out-of-network. | |
| This plan does not offer prescription drug coverage. | |
| Dental Services | Authorization rules may apply. |
| In general preventive dental benefits (such as cleaning) not covered. | |
| $30 copay for Medicare-covered dental benefits | |
| $35 copay for comprehensive dental benefits | |
| Hearing Services | Authorization rules may apply. |
| In general supplemental routine hearing exams and hearing aids not covered. | |
| $35 copay for hearing exams. | |
| Vision Services | Authorization rules may apply. |
| $0 copay for | |
| $35 copay for eye exams. | |
| $0 copay for eye exams. | |
| $0 copay for eye wear. | |
| Over-the-Counter Items | Please visit our plan website to see our list of covered Over-the-Counter items. OTC items may be purchased only for the enrollee. Please contact the plan for specific instructions for using this benefit. |
| Transportation | This plan does not cover supplemental routine transportation. |
| Acupuncture | This plan does not cover Acupuncture. |
| Premium and Other Important Information | In 2012 the monthly Part B Standard Premium is $99.90 and the annual Part B deductible amount is $140. |
| If a doctor or supplier does not accept assignment their costs are often higher which means you pay more. | |
| Most people will pay the standard monthly Part B premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. | |
| Doctor and Hospital Choice | You may go to any doctor specialist or hospital that accepts Medicare. |
| Inpatient Hospital Care | In 2012 the amounts for each benefit period are: Days 1 - 60: $1 156 deductible Days 61 - 90: $289 per day Days 91 - 150: $578 per lifetime reserve day |
| Call 1-800-MEDICARE (1-800-633-4227) for information about lifetime reserve days. | |
| Lifetime reserve days can only be used once. | |
| "A ""benefit period"" starts the day you go into a hospital or skilled nursing facility. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have." | |
| Inpatient Mental Health Care | In 2012 the amounts for each benefit period are: Days 1 - 60: $1 156 deductible Days 61 - 90: $289 per day Days 91 - 150: $578 per lifetime reserve day |
| You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital. | |
| Skilled Nursing Facility (SNF) | In 2012 the amounts for each benefit period after at least a 3-day covered hospital stay are: Days 1 - 20: $0 per day Days 21 - 100: $144.50 per day |
| 100 days for each benefit period. | |
| "A ""benefit period"" starts the day you go into a hospital or SNF. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have." | |
| Home Health Care | $0 copay. |
| Hospice | You pay part of the cost for outpatient drugs and inpatient respite care. |
| You must get care from a Medicare-certified hospice. | |
| Doctor Office Visits | 20% coinsurance |
| Chiropractic Services | Supplemental routine care not covered |
| 20% coinsurance for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers. | |
| Podiatry Services | Supplemental routine care not covered. |
| 20% coinsurance for medically necessary foot care including care for medical conditions affecting the lower limbs. | |
| Outpatient Mental Health Care | 40% coinsurance for most outpatient mental health services |
| Specified copayment for outpatient partial hospitalization program services furnished by a hospital or community mental health center (CMHC). Copay cannot exceed the Part A inpatient hospital deductible. | |
| """Partial hospitalization program"" is a structured program of active outpatient psychiatric treatment that is more intense than the care received in your doctor's or therapist's office and is an alternative to inpatient hospitalization." | |
| Outpatient Substance Abuse Care | 20% coinsurance |
| Outpatient Services/Surgery | 20% coinsurance for the doctor's services |
| Specified copayment for outpatient hospital facility services Copay cannot exceed the Part A inpatient hospital deductible. | |
| 20% coinsurance for ambulatory surgical center facility services | |
| Ambulance Services | 20% coinsurance |
| Emergency Care | 20% coinsurance for the doctor's services |
| Specified copayment for outpatient hospital facility emergency services. | |
| Emergency services copay cannot exceed Part A inpatient hospital deductible for each service provided by the hospital. | |
| You don't have to pay the emergency room copay if you are admitted to the hospital as an inpatient for the same condition within 3 days of the emergency room visit. | |
| Not covered outside the U.S. except under limited circumstances. | |
| Urgently Needed Care | 20% coinsurance or a set copay |
| NOT covered outside the U.S. except under limited circumstances. | |
| Outpatient Rehabilitation Services | 20% coinsurance |
| Durable Medical Equipment | 20% coinsurance |
| Prosthetic Devices | 20% coinsurance |
| Diabetes Programs and Supplies | 20% coinsurance for diabetes self-management training |
| 20% coinsurance for diabetes supplies | |
| 20% coinsurance for diabetic therapeutic shoes or inserts | |
| Diagnostic Tests X-Rays Lab Services and Radiology Services | 20% coinsurance for diagnostic tests and x-rays |
| $0 copay for Medicare-covered lab services | |
| Lab Services: Medicare covers medically necessary diagnostic lab services that are ordered by your treating doctor when they are provided by a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory that participates in Medicare. Diagnostic lab services are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare does not cover most supplemental routine screening tests like checking your cholesterol. | |
| Cardiac and Pulmonary Rehabilitation Services | 20% coinsurance Cardiac Rehabilitation services 20% coinsurance for Pulmonary Rehabilitation services 20% coinsurance for Intensive Cardiac Rehabilitation services |
| This applies to program services provided in a doctor+s office. Specified cost sharing for program services provided by hospital outpatient departments. | |
| Preventive Services and Wellness/Education Programs | No coinsurance copayment or deductible for the following: |
| Kidney Disease and Conditions | 20% coinsurance for renal dialysis |
| 20% coinsurance for kidney disease education services | |
| Outpatient Prescription Drugs | Most drugs are not covered under Original Medicare. You can add prescription drug coverage to Original Medicare by joining a Medicare Prescription Drug Plan or you can get all your Medicare coverage including prescription drug coverage by joining a Medicare Advantage Plan or a Medicare Cost Plan that offers prescription drug coverage. |
| Dental Services | Preventive dental services (such as cleaning) not covered. |
| Hearing Services | Supplemental routine hearing exams and hearing aids not covered. |
| 20% coinsurance for diagnostic hearing exams. | |
| Vision Services | 20% coinsurance for diagnosis and treatment of diseases and conditions of the eye. |
| Supplemental routine eye exams and glasses not covered. | |
| Medicare pays for one pair of eyeglasses or contact lenses after cataract surgery. | |
| Annual glaucoma screenings covered for people at risk. | |
| Over-the-Counter Items | Not covered. |
| Transportation | Not covered. |
| Acupuncture | Not covered. |
| Point of Service | You may go to any doctor specialist or hospital that accepts Medicare. |
Medicare Terms
- • Co-payment
- An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or a prescription. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or prescription.
- • Cost Plans
- A type of Medicare health plan available in some areas. In a Medicare Cost Plan, if you get services outside of the plan's network without a referral, your Medicare-covered services will be paid for under Original Medicare (your Cost Plan pays for emergency services, or urgently needed services).
- • Deductible
- The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
- • HMO - Health Maintenance Organization
- Local HMOs are plans with defined networks of providers, which beneficiaries must use in order to receive coverage, serving specific geographic areas consisting of aggregations of counties.
- • HMO SNP - Special Needs Plan
- Medicare Special Needs Plans are a type of Medicare Advantage Plan (Part C) for people with certain chronic diseases and conditions or who have specialized needs (such as people who have both Medicare and Medicaid or people who live in certain institutions). Medicare SNPs provide their members with all Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance) services, and Medicare prescription drug coverage (Part D). Medicare SNPs were created to give certain groups of people better access to Medicare with plans designed to meet their unique needs.
- • HMO with POS Option
- An HMO POS is a Medicare Advantage Plan that is a Health Maintenance Organization with a more flexible network allowing Plan Members to seek care outside of the traditional HMO network under certain situations or for certain treatment.
- • LPPO - Local Preferred Provider Organization
- Local PPOs are network based plans that serve specific geographic areas consisting of aggregations of counties, like HMOs, but with more flexibility in provider choice within the network. Beneficiaries may use providers outside the network but will pay more out of pocket cost.
Related Links
- Medicare.gov
The official U.S. Government site for Medicare - AARP
American Association of Retired Persons - HHS.gov
United States Department of Health & Human Services - CMS.gov
Centers for Medicare & Medicaid Services - Social Security Administration
The official website of the U.S. Social Security Administration
Help is available. If you have limited income and resources, you may qualify for help paying your Medicare health care and/or prescription drug coverage costs. For more information, visit socialsecurity.gov, call Social Security at 1-800-772-1213, or apply for help at your State Medical Assistance (Medicaid) office.
If you have questions about Medicare, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
