Humana Honor (PPO) - 2023 Humana (2024)

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H5216 - 355 - 0

Humana Honor (PPO) - 2023 Humana (1) (4.5 / 5)

Humana Honor (PPO) - 2023 Humana (2)

Humana Honor (PPO)is a Medicare Advantage (Part C) Plan by Humana.

This page features plan details for 2023 Humana Honor (PPO)H5216 – 355 – 0 available in Select Counties in IL, WI.

IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:

Locations

Humana Honor (PPO)is offered in the following locations.

Adams County, Illinois

Adams County, Wisconsin

Ashland County, Wisconsin

Plan Overview

Humana Honor (PPO)offers the following coverage and cost-sharing.

Insurer:Humana
Health Plan Deductible:$0.00
MOOP:$8,950 In and Out-of-network
$4,900 In-network
Drugs Covered:No

Ready to sign up for Humana Honor (PPO)?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.

Humana Honor (PPO)qualifies for a monthly Medicare Give Back Benefit of $125.00.

Premium Reduction:$125.00

Premium Breakdown

Humana Honor (PPO)has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.

Part BPart CPart B Give BackTotal
$164.90$0.00$125.00$39.90

Please Note:

  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Humana Honor (PPO)also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: No

Dental (comprehensive)

Diagnostic services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Diagnostic services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Endodontics:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Endodontics:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Extractions:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Extractions:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Non-routine services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Non-routine services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Periodontics:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Periodontics:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Restorative services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Restorative services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)

Dental (preventive)

Cleaning:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Cleaning:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Oral exam:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Oral exam:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI):In-Network: $0-295 copay (authorization required) (referral not required)
Diagnostic radiology services (e.g., MRI):Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Diagnostic tests and procedures:In-Network: $0-95 copay (authorization required) (referral not required)
Diagnostic tests and procedures:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Lab services:In-Network: $0-40 copay (authorization required) (referral not required)
Lab services:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Outpatient x-rays:In-Network: $15-95 copay (authorization required) (referral not required)
Outpatient x-rays:Out-of-Network: 50% coinsurance (authorization required) (referral not required)

Doctor visits

Primary:In-Network: $15 copay per visit
Primary:Out-of-Network: 50% coinsurance per visit
Specialist:In-Network: $45 copay per visit (authorization not required) (referral not required)
Specialist:Out-of-Network: 50% coinsurance per visit (authorization not required) (referral not required)

Emergency care/Urgent care

Emergency: $110 copay per visit (always covered)
Urgent care: $25 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment:In-Network: $45 copay (authorization required) (referral not required)
Foot exams and treatment:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Routine foot care: Not covered

Ground ambulance

In-Network: $290 copay
Out-of-Network: $290 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation:In-Network: $0 copay (no limits) (authorization required) (referral not required)
Fitting/evaluation:Out-of-Network: $0 copay (no limits) (authorization required) (referral not required)
Hearing aids:In-Network: $699-999 copay (limits may apply) (authorization not required) (referral not required)
Hearing aids:Out-of-Network: $699-999 copay (limits may apply) (authorization not required) (referral not required)
Hearing exam:In-Network: $45 copay (authorization required) (referral not required)
Hearing exam:Out-of-Network: 50% coinsurance (authorization required) (referral not required)

Hospital coverage (inpatient)

In-Network: $295 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond (authorization required) (referral not required)
Out-of-Network: 50% per stay (authorization required) (referral not required)

Hospital coverage (outpatient)

In-Network: $0-295 copay per visit (authorization required) (referral not required)
Out-of-Network: 50% coinsurance per visit (authorization required) (referral not required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$8,950 In and Out-of-network
$4,900 In-network

Medical equipment/supplies

Diabetes supplies:In-Network: $0 copay or 10-20% coinsurance per item (authorization required)
Diabetes supplies:Out-of-Network: 50% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):In-Network: 20% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):Out-of-Network: 20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):In-Network: 15% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):Out-of-Network: 50% coinsurance per item (authorization required)

Medicare Part B drugs

Chemotherapy:In-Network: 20% coinsurance (authorization required)
Chemotherapy:Out-of-Network: 50% coinsurance (authorization required)
Other Part B drugs:In-Network: 20% coinsurance (authorization required)
Other Part B drugs:Out-of-Network: 50% coinsurance (authorization required)

Mental health services

Inpatient hospital – psychiatric:In-Network: $295 per day for days 1 through 6
$0 per day for days 7 through 90 (authorization required) (referral not required)
Inpatient hospital – psychiatric:Out-of-Network: 50% per stay (authorization required) (referral not required)
Outpatient group therapy visit:In-Network: $45 copay (authorization required) (referral not required)
Outpatient group therapy visit:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist:In-Network: $45 copay (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Outpatient individual therapy visit:In-Network: $45 copay (authorization required) (referral not required)
Outpatient individual therapy visit:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:In-Network: $45 copay (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:Out-of-Network: 50% coinsurance (authorization required) (referral not required)

Optional supplemental benefits

Yes

Preventive care

In-Network: $0 copay (authorization not required) (referral not required)
Out-of-Network: $0 copay or 50% coinsurance (authorization not required) (referral not required)

Rehabilitation services

Occupational therapy visit:In-Network: $40 copay (authorization required) (referral not required)
Occupational therapy visit:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Physical therapy and speech and language therapy visit:In-Network: $40 copay (authorization required) (referral not required)
Physical therapy and speech and language therapy visit:Out-of-Network: 50% coinsurance (authorization required) (referral not required)

Skilled Nursing Facility

In-Network: $0 per day for days 1 through 20
$196 per day for days 21 through 100 (authorization required) (referral not required)
Out-of-Network: 50% per stay (authorization required) (referral not required)

Transportation

Not covered

Vision

Contact lenses:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Contact lenses:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Eyeglass frames: Not covered (no limits)
Eyeglass lenses: Not covered (no limits)
Eyeglasses (frames and lenses):In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Eyeglasses (frames and lenses):Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Other: Not covered (no limits)
Routine eye exam:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Routine eye exam:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Upgrades: Not covered

Wellness programs (e.g., fitness, nursing hotline)

Covered (authorization not required) (referral not required)

Optional Benefits

Package #1

Preventive dental:Monthly Premium:$39.90
Preventive dental:Deductible:N/A
Comprehensive dental:Monthly Premium:$39.90
Comprehensive dental:Deductible:N/A

Ready to sign up for Humana Honor (PPO)?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Table of Contents

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Every year, Medicare evaluates plans based on a 5-star rating system.

Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

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Humana Honor (PPO) - 2023 Humana (2024)
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