4

4 out of 5 stars* for plan year 2024

Plan ID: H5216-254

What You Need to Know:

  • HumanaChoice H5216-254 (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 $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $250 (Tier 1, 2 and 3 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $4,050 per year (in-network).
  • HumanaChoice H5216-254 (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $250 (Tier 1, 2 and 3 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $0.

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

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$0 $0 $0 $0 $0 $250.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H5216-255
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): $4,050
Annual Deductible: $250 (Tier 1, 2 and 3 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Sarpy, Nebraska: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
95 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 Sarpy, Nebraska: 663 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
$0.00 $0.00 $0.00 $0.00
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
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
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 $4.00 599 $16.00 788 $47.00 1084 $100.00 684 28%

Other Medicare Advantage Plans in Sarpy, Nebraska

Plan Name Type Premium MOOP Rx Deduct. Rating
Humana Value Plus H5216-171 (PPO) (2023)Local PPO$6,700$305
4
Bright Advantage Choice (PPO) (2023)Local PPO$4,500$445
New plan - not yet rated.
Bright Advantage Choice Plus (PPO) (2023)Local PPO$4,500$175
New plan - not yet rated.
Aetna Medicare Premier (HMO) (2023)Local HMO$5,900$0
5
Bright Advantage (HMO) (2023)Local HMO$4,700$445
5
Aetna Medicare Prime (HMO) (2023)Local HMO$5,000$0
5
Bright Advantage Plus (HMO) (2023)Local HMO$3,900$445
5
Blue Cross Blue Shield Nebraska MA Access (PPO) (2023)Local PPO$4,500$100
New plan - not yet rated.
AARP Medicare Advantage (HMO-POS) (2023)Local HMO$4,900$250
5
Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) (2023)Local HMO$5,700$150
4
Aetna Medicare Elite (PPO) (2023)Local PPO$6,100$0
4
Blue Cross Blue Shield Nebraska MA Core (HMO) (2023)Local HMO$6,250$250
4
Medica Advantage Solution H3632-001 (PPO) (2023)Local PPO$5,500$0
New plan - not yet rated.
HumanaChoice H5216-014 (PPO) (2023)Local PPO$6,700$350
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Humana Gold Plus H0028-011 (HMO) (2023)Local HMO$3,850$150
4
Medica Advantage Solution with CHI Health (HMO) (2023)Local HMO$5,500$250
New plan - not yet rated.
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$3,900$0
5
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$6,700$-
5
Aetna Medicare Premier (PPO) (2023)Local PPO$6,100$0
4
Medicare Advantage Plans by Humana
Humana Value Plus H5216-171 (PPO) (2023)Local PPO$6,700$305
4
HumanaChoice H5216-014 (PPO) (2023)Local PPO$6,700$350
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Humana Gold Plus H0028-011 (HMO) (2023)Local HMO$3,850$150
4

Find Medicare Advantage Plans in Nebraska