Humana Together in Health (I-SNP) Plan Details for Grant County, WV
This page provides coverage and cost details for Humana’s H5216-447-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*CMS rated this Humana plan (H5216-447-0) 3.5 (Above Average) out of 5 stars.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Institutional SNP qualification requirements to join this I-SNP plan.
Humana Together in Health Basic Plan Details
- Plan ID
- H5216-447-0
- Plan Type
- PPO I-SNP
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 9,350.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced
$470.00 deductible - Supplemental Benefits
- Vision, Hearing
- Availability
- Grant County, WV
- Insured By
- Humana
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Humana plan:
Doctor's Office Visits
- Primary
- $0 Copay
- Specialist
- 20% Coinsurance
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $110 Copay
- Urgent care
- 20% Coinsurance
- Ground ambulance
- 20% Coinsurance
- Inpatient hospital care
- $598.00 per day for days 1 through 4
$0.00 per day for days 5 and beyond - Skilled Nursing Facility
- $0.00 per day for days 1 through 100
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- 20% Coinsurance
Prior Authorization Required - Routine Foot Care
- 20% Coinsurance
Prior Authorization Required
Chiropractic Care
- Medicare-covered chiropractic
- $0 Copay
Prior Authorization Required - Routine chiropractic
- $0 Copay
Prior Authorization Required
Mental Health Services
- Outpatient individual therapy
- 20% Coinsurance
- Outpatient group therapy
- 20% Coinsurance
- Inpatient psychiatric hospital care
- $1,872.00 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- $0 Copay
Prior Authorization Required - Occupational therapy
- $0 Copay
Prior Authorization Required
Medical Equipment and Supplies
- Diabetes supplies
- 20% Coinsurance
Prior Authorization Required - Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- 20% Coinsurance
Prior Authorization Required - Lab services
- 20% Coinsurance
Prior Authorization Required - Outpatient x-rays
- 20% Coinsurance
Prior Authorization Required - Diagnostic tests and procedures
- 20% Coinsurance
Prior Authorization Required
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- 20% Coinsurance
Prior Authorization Required - Oral exam
- $0 Copay
- Dental x-rays
- $0 Copay
- Cleaning
- $0 Copay
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
- Maximum dental benefit
- $2,000.00 (Every year)
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Covered
Limits may apply - Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- 20% Coinsurance
- Routine eye exam
- $0 Copay
1 Every year - Eyewear benefits
- Eyeglasses: No
Contact Lenses: No
Eyeglass Lenses: No
Eyeglass Frames: No
Eyewear Upgrades: No - Maximum eyewear benefit:
- $2.00
Every three years
Prescription Drug Costs & Benefits
Humana Together in Health includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $470.00. You must pay this amount at the pharmacy before Humana begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Humana Together in Health has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $10.00 |
| Generic | $0.00 | $20.00 |
| Preferred Brand | 25.00% | 25.00% |
| Non-Preferred Drug | 25.00% | 25.00% |
| Specialty Tier | 25.00% | 25.00% |
| *The Part D deductible does not apply. | ||
5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage I-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this Humana plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
Humana Together in Health
To be eligible to enroll in Humana Together in Health , you must meet three requirements:
- You are eligible for Medicare;
- You live in Grant County (the plan’s service area); and
- You require the level of care provided in an institutionalized setting, such as a long-term care nursing facility, for 90 days or more.
If you live at home and require an equivalent level of skilled care, you may be eligible for an Institutional Equivalent Special Needs Plan (IE-SNP).
Before joining Humana Together in Health , consider these questions:
- Does the plan's provider network include my nursing home or home care provider?
- What costs should I expect with my coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket costs?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary?
- What special accommodations does the plan make for persons with disabilities?
- What special language and cultural accommodations does the plan make?
Additional I-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Us About Humana
| Website: | Humana Plan Page (opens in new tab) |
|---|---|
| Providers: | Humana Providers Page (opens in new tab) |
| Formulary: | Humana Formulary Page (opens in new tab) |
| Pharmacy: | Humana Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (800)833-2364 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)833-2364 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits 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.
Health Plan Compatibility
Medicare Advantage Special Need Plans are not compatible with most other forms of health insurance. If you have Medicare Part A and/or Medicare Part B and join a SNP plan, you will be disenrolled from Original Medicare. You cannot simultaneously enroll in an SNP plan and Medicare Supplement Insurance.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- Humana, http://www.humana.com/medicare, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in West Virginia", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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