HumanaChoice H5216-116 2020 Medicare Advantage PPO Plan for Berks County, PA
HumanaChoice H5216-116 is a Medicare Advantage plan from Humana that's available to Medicare beneficiaries living in Berks County, Pennsylvania.
- It is a Preferred Provider Organization (PPO) health plan.
- It provides the same basic benefits as Original Medicare.
- It may offer extras that Medicare does not cover.
- The maximum out-of-pocket cost with this plan is $3,900 .
- The monthly premium is $0.00 (plus your Part B premium).
- NOTE: It does not include a prescription drug plan (Part D).
HumanaChoice H5216-116 vs. Original Medicare in Berks County
This PPO plan replaces your traditional Medicare coverage in Berks County. If you join HumanaChoice H5216-116, you must agree to let Humana manage your Medicare benefits, including:
- Medicare Part A (hospital insurance).
- Medicare Part B (medical insurance).
- Additional benefits included in the plan not covered by Medicare.
PPO health insurance allows you to choose your own primary care doctor, specialists and other healthcare providers. If you're on a budget you can lower your out-of-pocket costs by using the plan's provider network.
HumanaChoice H5216-116 Review
These are the areas of the plan that are important to compare and review:
- Premium: This is the amount you will pay monthly, above and beyond your Medicare Part B.
- Maximum-Out-Of-Pocket (MOOP): This is the most you will pay for co-pays and co-insurance before the plan pays 100%.
- CMS Ratings: Important measurements across 5 different areas that will help you understand how well this plan will care for you.
- Prescription Coverage: Not included with this plan.
- Co-pays & Co-insurance: If you see the doctor regularly, including specialists, you need to know what you'll pay for each visit.
IMPORTANT: Unlike Original Medicare, your out-of-pocket expenses are capped with this plan. As a result, you won't be vulnerable to excessive medical bills due to an accident or a critical illness.
NOTE: HumanaChoice H5216-116 does not include a drug plan. To get prescription coverage, add one of the stand-alone Medicare Drug Plans in Pennsylvania. Coverage by prescription drug plans varies, so make sure you get the coverage you need.
The monthly premium if you join HumanaChoice H5216-116 is $0.00 per month. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventative care mandated by CMS (see H5216-116 Summary of Benefits below).
IMPORTANT: When evaluating this plan, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.
Maximum Out-of-Pocket (MOOP) Limit
Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The HumanaChoice H5216-116 plan MOOP is $3,900 . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.
Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.
NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.
CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medicare Supplement in Berks County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.
For more information about this plan, call the Enrollment Assistance line, or visit the Enrollment Website or the plan website:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov. To learn more about this plan, visit the Humana Medicare website.
Additional Medicare Plan Options in Berks County
Are you eligible for a Berks County, PA Medicare Special Needs Plan (SNP)? SNPs are a special type of Medicare Advantage plan designed to help people with special needs. Here are some of the SNP plans in your area:
- BlueJourney Alliance Lung Care (Local HMO), for Chronic or Disabling Condition beneficiaries
- Aetna Medicare Advantra Cares (Local HMO), for Dual-Eligible beneficiaries
- UPMC for Life Dual (Local HMO), for Dual-Eligible beneficiaries
- Gateway Health Medicare Assured Diamond (Local HMO), for Dual-Eligible beneficiaries
- Health Partners Medicare Special (Local HMO), for Dual-Eligible beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- Geisinger Gold Classic Essential Rx (HMO)
- Aetna Medicare Advantra Premier (HMO)
- BlueJourney Prime (PPO)
- Aetna Medicare Gold Plan (PPO)
- AARP Medicare Advantage Choice Plan 2 (PPO)