HumanaChoice H6609-012 (PPO)
Medicare Advantage Plans (Part C)
- HumanaChoice H6609-012 (PPO)
- 2012 Plan
|Office Visit for Primary Doctor||$10 copay for each primary care doctor visit for Medicare-covered benefits.|
|Office Visit for Specialist||$25 to $30 copay for each specialist visit for Medicare-covered benefits.|
|Doctor Choice||Plan Doctor Only|
|Prescription Drug Coverage||No|
|Physical Exams||$0 copay for all preventive services covered under Original Medicare at zero cost sharing.|
|Hospital Services Coverage|
|Emergency Room||$65 copay for Medicare-covered emergency room visits.
If you are admitted to the hospital within 24-hour(s) for the same condition, you pay $0 for the emergency room visit.
|Ambulance Services||$150 copay for Medicare-covered ambulance benefits.|
|Outpatient Lab/X-Ray||$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.
|Outpatient Surgery||$125 copay for each Medicare-covered ambulatory surgical center visit.
$30 to $175 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit.
|Urgent Care||30% of the cost for Medicare-covered urgently needed care visits.|
|Hospitalization||No limit to the number of days covered by the plan each benefit period.
For Medicare-covered hospital stays: Days 1 - 5: $275 copay per day;
Days 6 - 90: $0 copay per day;
$0 copay for each additional hospital day.
|Outpatient Rehabilitation Services||$50 copay for Medicare-covered Occupational Therapy visits.
$50 copay for Medicare-covered Physical and/or Speech and Language Therapy visits.
|Skilled Nursing Facility||Plan covers up to 100 days each benefit period.
No prior hospital stay is required.
For SNF stays: Days 1 - 7: $0 copay per day;
Days 8 - 20: $50 copay per day;
Days 21 - 100: $100 copay per day.
|Home Health Care||$0 copay for each Medicare-covered home health visit.|
|Hospice||You must get care from a Medicare-certified hospice.
Your plan will pay for a consultative visit before you select hospice.
|Prescription Drug Coverage|
|Prescription Drug Deductible||$0|
|Retail Pharmacy for Prescription Drugs|
|Mail Order Pharmacy for Prescription Drugs|
|Dental Services||In general, preventive dental benefits (such as cleaning) not covered.
$25 copay for Medicare-covered dental benefits.
|Hearing Services||In general, routine hearing exams and hearing aids not covered.
- $25 copay for Medicare-covered diagnostic hearing exams.
|Vision Services||$0 copay for- one pair of eyeglasses or contact lenses after cataract surgery;
- $0 to $25 copay for exams to diagnose and treat diseases and conditions of the eye;
- $0 copay for up to 1 supplemental routine eye exam(s) every year.
|Chiropractic Coverage||$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.
|Outpatient Mental Health Coverage||$25 copay cost for each Medicare-covered individual therapy visit;
$25 copay cost for each Medicare-covered group therapy visit;
$25 copay for each Medicare-covered individual therapy visit with a psychiatrist;
$25 copay for each Medicare-covered group therapy visit with a psychiatrist;
$50 copay for Medicare-covered partial hospitalization program services.
(See more benefit details,
including Out of Network coverage)
|See more benefit details:
Summary of Benefits
|Medicare Brochure(s)||Medicare & You|
- You can always call our licensed agents at 1 -800-299-3116 (TTY User: 711) Mon - Fri 8AM - 8PM ET, Sat 9AM - 6PM ET if you have questions, need help comparing plans, or to complete your enrollment.
- Humana is a Medicare Advantage organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in a/this Humana plan depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
- Limitations, copayments and restrictions may apply. [Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance] may change on January 1 of each year
- Limitations, copayments, and restrictions may apply.
- Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
- You must continue to pay your Medicare Part B premium.
- For Humana RPPO only: Sometimes the selection of in-network providers is limited in certain geographic areas or in some specialties. If the network in your area doesn't offer the specialist you need, you may be allowed to go to a non-network provider at the in-network rate. Be sure to contact non-network doctors before you see them to make sure they accept Medicare assignment and have agreed to accept payment from Humana.
- You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your Medicaid Office.
- Medicare beneficiaries may also enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
- Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
- Not every plan is available statewide or in all service areas.