MOHK7GUEN MEDICARE ADVANTAGE PLANS Select the market(s) below to view their Market Highlights MISSOURI MA/MAPD PLANS Humana offers a wide range of affordable plans and a broad network of healthcare providers nationwide to meet the unique needs of your clients. Many plans come with low or no monthly plan premium, plus health-boosting benefits that aim to help your clients achieve their best health.
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MEDICARE ADVANTAGE PLANS MISSOURI · 2019-02-23 · MOHK7GUEN MEDICARE ADVANTAGE PLANS MISSOURI Select the market(s) below to view their Market Highlights MA/MAPD PLANS Humana offers
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MOHK7GUEN
MEDICARE ADVANTAGE PLANS
Select the market(s) below to view their Market HighlightsMISSOURI
MA/MAPD PLANS
Humana offers a wide range of affordable plans and a broad network of healthcare providers nationwide to meet the unique needs of your clients. Many plans come with low or no monthly plan premium, plus health-boosting benefits that aim to help your clients achieve their best health.
DSNP AND VALUE PLUS PLANS
MISSOURI
DSNP AND VALUE PLUS PLANS
DSNP AND VALUE PLUS
PRESCRIPTION DRUG PLANS
MISSOURI
PDP PLANS
Humana offers affordable prescription drug plans that meet the unique needs of your clients. Our vast network includes mail-order pharmacies like Humana Pharmacy, which offers mail-order copays as low as $0 on generic drugs in many regions. In-store copays as low as $1 on certain generic drugs at Walmart, Sam’s Club, and Walmart Neighborhood Markets, which are preferred cost sharing pharmacies.
PDP
LOCAL SUPPORT
MISSOURI
LOCAL SUPPORT
LOCAL SUPPORT
Humana now offers two new resources, Broker Relationship Managers (BRM) and Broker Relationship Executives (BRE), in addition to your local market offices. BRMs have been deployed in markets across the country to offer on-the-ground assistance, BREs to provide sales support telephonically and electronically. We encourage you to contact these resources or simply contact Humana Agent Support at 1-800-309-3163.
MEDICARE ADVANTAGE PLANS
MARKET HIGHLIGHTS• New $0 plan premium HMO and Current
HMO plan at $18 plan premium. Both plans service areas include Springfield and Joplin. No segmented plans anymore
• $0 PCP copay on HMO plans
• No referrals required on HMO plans
• Those who qualify for LIS will get help on plan premiums when offered
• Many plans include Dental, Vision, Hearing, OTC, SilverSneakers and more
• MAPD plans offer preferred Rx cost shares with $0 copay for tiers 1 & 2 Humana pharmacy 90-day mail order
• ED Rx covered on select plan HMO and LPPO plans
• Go365 on select plans. Members can earn up to $300 in gift cards and Go365 bucks can be spent in Go365 mall
NETWORK HIGHLIGHTS• Mercy, Freeman are some of the providers
that are in network
• LPPOs and RPPOs have a national network. Receive in network benefits when visiting in network facilities outside of plan service area
MARKET SERVICE AREABarry, Lawrence, Mcdonald, Newton
MISSOURI JOPLIN
NEW
Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO)
Plan Number H4623-001-000 H0028-016-000 H5216-033-001
Plan Highlights$0 HMO, $0 PCP, $3400 MOOP, No Rx ded, 2K dental/denture cov, vision, hearing, OTC allowance, SilverSneakers and more
Low premium plan, with dental, vision, hearing, SilverSneakers, OTC allowance and more
$35 plan premium LPPO MAPD, $0 Rx ded, SilverSneakers, vision, hearing, OTC allowance and more
Premium $0 $18 $35
PCP $0 $0 $15
Specialist $40 $45 $45
Referrals Required No No No
Inpatient Hospital $295 per day Days 1-5 $295 per day Days 1-5 $295 per day Days 1-5
Max Out-of-Pocket $3,400 In-network $5,900 In-network $6,700 In-network
Rx Deductible No Deductible $195 tiers 4-5 No Deductible
Rx Preferred
$6/$11/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$6/$11/$47/$99/29%; $$0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$8/$15/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter
Market Service Area McDonald, Newton Barry, Lawrence Statewide in Arkansas, Missouri
MISSOURI | JOPLIN MA/MAPD PLANS
Plan Name Humana Gold Choice (PFFS) HumanaChoice (PPO) HumanaChoice (Regional PPO)
Plan Number H8145-125-000 H5216-140-000 R1532-001-000
Plan Highlights Missouri network PFFS$0 LPPO MA only with $40 part B premium giveback, ideal for veterans using the VA for Rx or people who have no Rx coverage
RPPO MA only $0 plan premium with $30.50 Part B premium giveback. Not commissionable in LPPO service area
Premium $81 $0 $0
PCP $15 $0 $0
Specialist $45 $35 $35
Referrals Required No No No
Inpatient Hospital $295 per day Days 1-5 $360 per day Days 1-5 $295 per day Days 1-5
Max Out-of-Pocket $6,700 In-network $4,900 In-network $3,900 In-network
Rx Deductible $195 tiers 3-5 No Coverage No Coverage
Rx Preferred
$8/$15/$47/$99/29%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
Plan Name HumanaChoice (PPO) HumanaChoice (PPO) Humana Gold Choice (PFFS)
Plan Number H5216-032-000 H5216-140-000 H8145-120-000
Plan Highlights KS-MO High Option LPPO$0 LPPO MA only with $40 part B premium give back, ideal for veterans using the VA for Rx or people who have no Rx coverage
Networked MA only PFFS in select counties in AR/KS/MO and OK
Premium $83 $0 $43
PCP $20 $0 $20
Specialist $50 $35 $50
Referrals Required No No No
Inpatient Hospital $360 per day Days 1-5 $360 per day Days 1-5 $360 per day Days 1-5
Max Out-of-Pocket $6,700 In-network $4,900 In-network $6,700 In-network
Rx Deductible $195 tiers 4-5 No Coverage No Coverage
Rx Preferred
$8/$15/$47/$99/29%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
No Coverage No Coverage
Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter
Plan Name Humana Gold Choice (PFFS) Humana Gold Choice (PFFS) HumanaChoice (PPO)
Plan Number H8145-125-000 H2944-013-000 H5216-140-000
Plan Highlights Missouri network PFFS MAPD Partial network PFFS MAPD$0 plan premium LPPO MA only $40 part B premium giveback, ideal for veterans using the VA for Rx or people w/ no Rx coverage
Premium $81 $99 $0
PCP $15 $15 $0
Specialist $45 $45 $35
Referrals Required No No No
Inpatient Hospital $295 per day Days 1-5 $295 per day Days 1-5 $360 per day Days 1-5
Max Out-of-Pocket $6,700 In-network $6,700 In-network $4,900 In-network
Rx Deductible $195 tiers 3-5 $195 tiers 3-5 No Coverage
Rx Preferred
$8/$15/$47/$99/29%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$7/$14/$47/$99/29%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
Market Service Area Statewide in Arkansas, Missouri Jefferson, Saint Charles, Saint Louis, Saint Louis City, Washington
MISSOURI | ST. LOUIS MA/MAPD PLANS
MISSOURI
DUAL-ELIGIBLE SPECIAL NEEDS PLANS (DSNP)Humana’s DSNPs offer beneficiaries who qualify for both Medicare and Medicaid with $0 or low cost copays for many medical and pharmacy services, as well as rich supplemental benefits like dental coverage, eye exams and glasses, over-the-counter allowance, hearing aids, and more. DSNPs allow year-round enrollment. Eligible members must meet Medicaid requirements to enroll in these plans.
VALUE PLUS PLANSA Value Plus Plan is a Medicare Advantage plan offered by Humana with those eligible for both Medicare and Medicaid in mind, but since it’s a Medicare Advantage plan, it’s available to anyone with Medicare.
Dual-Eligible Medicare and Medicaid beneficiaries will receive $0 or low cost copays for many medical and pharmacy services, as well as rich supplemental benefits like dental coverage,
eye exams and glasses, over-the-counter allowance, hearing aids, and more. Dual eligibles may enroll in this plan year-round. Unlike a DSNP, if a beneficiary loses Medicaid status, they are not required to change health plans – they will keep this plan, but will lose their Medicaid benefits.
Value Plus Plans also appeal to Medicare beneficiaries who are familiar with Original Medicare benefits and cost sharing, who also desire pharmacy coverage and rich supplemental benefits.
DSNP AND VALUE PLUS PLANS
MISSOURI DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW
Plan Name Humana Gold Plus SNP-DE (HMO SNP)Plan Number H0028-015-000
Plan Highlights HMO counties, 2500 dental/with dentures, vision, OTC $275Qtr allowance, $0 copay hearing aids & more
Vision Annual exam and $300 credit every year for eyeglasses or contact lenses
Hearing $0 annual exams, fittings and TruHearing advanced level hearing aids plus 48 batteries
OTC Allowance OTC $275/Quarter for select health and wellness products
Transportation Up to 48 one-way trips to approved locations and fitness centers per year
Current Service AreaBarry, Cass, Cedar, Christian, Clay, Dade, Dallas, Douglas, Greene, Howell, Jackson, Jasper, Jefferson, Johnson, Laclede, Lafayette, Lawrence, McDonald, Newton, Platte, Polk, Pulaski, Saint Charles, Saint Francois, Saint Louis, Saint Louis City, Stone, Taney, Warren, Washington, Webster, Wright
MISSOURI DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW
NEW
Plan Name HumanaChoice SNP-DE (PPO SNP)Plan Number H5216-164-000
Plan Highlights New in 2019, LPPO counties, $2500 dental/dentures, vision, OTC $300 Qtr allowance, $0 copay hearing aids & more
Vision Annual exam and $200 credit every year for eyeglasses or contact lenses. OON coverage available. Some restrictions apply if benefits received Out-of-Network
Hearing $0 annual exam, fittings and TruHearing advanced level hearing aids plus 48 batteries
OTC Allowance OTC $300/Quarter for select health and wellness products
Transportation Up to 48 one-way trips to approved locations and fitness centers per year