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HumanaChoice Value H2029-001 (PPO) - H2029-001-000
$46.00
Monthly Premium
HumanaChoice Value H2029-001 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H2029-001-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$46.00
Monthly Premium
Puerto Rico Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.
Learn more about Puerto Rico Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
Enrollment may be limited to certain times of the year. See why you may be able to enroll.
Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $46.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $0.00 |
| Out-of-pocket maximum | $6,700.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,000.00 |
| Primary care doctor visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0 |
| Specialty doctor visit | In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $8 |
| Inpatient hospital care | In-Network: Acute Hospital Services: Copayment for Acute Hospital Services per Stay $0 Prior Authorization Required for Acute Hospital Services |
| Urgent care | Urgent Care: Copayment for Urgent Care $15 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $75 |
| Emergency room visit | Emergency Care: Copayment for Emergency Care $75 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $75 Copayment for Worldwide Emergency Transportation $75 |
| Ambulance transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $100 Air Ambulance: Coinsurance for Air Ambulance Services 20% Prior Authorization Required for Air Ambulance |
Health Care Services and Medical Supplies
HumanaChoice Value H2029-001 (PPO) covers a range of additional benefits. Learn more about HumanaChoice Value H2029-001 (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
| Coverage | Details |
|---|---|
| Chiropractic services | In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15 |
| Diabetes supplies, training, nutrition therapy and monitoring | Out-of-Network: Medicare Covered Diabetic Supplies and Services: Coinsurance for Medicare Covered Diabetic Supplies 50% Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 50% |
| Durable medical equipment (DME) | In-Network: Durable Medical Equipment: Copayment for Medicare-covered Durable Medical Equipment $0 Coinsurance for Medicare-covered Durable Medical Equipment 5% Prior Authorization Required for Durable Medical Equipment $0 Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy$0 DME-All Other - DME Prov$0 DME-All Other - Pharmacy5% DME-High Cost - DME Prov5% DME-High Cost - Pharmacy |
| Diagnostic tests, lab and radiology services, and X-rays | Out-of-Network: Medicare Covered Diagnostic Procedures/Tests Services: Coinsurance for Medicare Covered Diagnostic Procedures/Tests 50% Coinsurance for Medicare Covered Lab Services 50% Coinsurance for Medicare Covered Diagnostic Radiological Services 50% Coinsurance for Medicare Covered Therapeutic Radiological Services 50% Coinsurance for Medicare Covered Outpatient X-Ray Services 50% $50 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$8 OP Diag Proc & Tests - SPC$15 OP Diag Proc & Tests - UCC$50 Sleep Study (Fac Based) - OPH$8 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home |
| Home health care | Out-of-Network: Medicare Covered Home Health Services: Coinsurance for Medicare Covered Home Health 50% |
| Mental health inpatient care | Out-of-Network: Psychiatric Hospital Services: Coinsurance for Psychiatric Hospital per Stay 50% |
| Mental health outpatient care | Out-of-Network: Medicare Covered Mental Health Services: Coinsurance for Medicare Covered Individual Sessions 50% Coinsurance for Medicare Covered Group Sessions 50% |
| Outpatient services/surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $20 to $50 Prior Authorization Required for Outpatient Hospital Services $50 Diag Colonoscopy - OPH$50 Mental Health - OPH$50 Surgery Svcs - OPH$20 Wound Care - OPH Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $0 Prior Authorization Required for Outpatient Observation Services Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 to $8 Prior Authorization Required for Ambulatory Surgical Center Services $8 Diag Colonoscopy - ASC$0 Surgery Svcs - ASC |
| Outpatient substance abuse care | Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 50% Coinsurance for Medicare Covered Group Sessions 50% $50 OP Substance Abuse Care - OPH$8 OP Substance Abuse Care - SPC |
| Over-the-counter items | In-Network: Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0
|
| Podiatry services | Out-of-Network: Medicare Covered Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 50% |
| Skilled Nursing Facility (SNF) care | In-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $25 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services |
Dental Benefits
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Dental care | 0% coinsurance for bitewing x-rays up to 1 set(s) every 2 years. 0% coinsurance for periodontal surgery up to 1 per quadrant every 3 years. 0% coinsurance for amalgam or composite filling up to 1 per tooth every 3 years. 0% coinsurance for comprehensive oral exam, cone beam CT imaging, panoramic film up to 1 every 3 years. 0% coinsurance for crown, implant supported prosthetics up to 1 per tooth every 5 years. 0% coinsurance for bridges, complete dentures, complete or partial denture reline, partial dentures up to 1 every 5 years. 0% coinsurance for implant services, other restorative services - core buildup and prefabricated post and core up to 1 per tooth per lifetime. 0% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant per year. 0% coinsurance for periodontal debridement up to 1 per year. 0% coinsurance for pulp vitality test up to 2 per quadrant per year. 0% coinsurance for periodic oral exam, periodontal maintenance, prophylaxis (cleaning) up to 2 per year. 0% coinsurance for complete or partial denture repair up to 3 per year. 0% coinsurance for intraoral x-rays up to 6 per year. 0% coinsurance for adjustments to dentures, extractions, root canal up to unlimited per year. $1,500 combined maximum benefit coverage amount per year for adjustments to dentures, bridges, complete dentures, complete or partial denture reline, complete or partial denture repair, crown, implant services, implant supported prosthetics, other restorative services - core buildup and prefabricated post and core, partial dentures comprehensive benefits.Out of Network50% coinsurance for bitewing x-rays up to 1 set(s) every 2 years. 50% coinsurance for periodontal surgery up to 1 per quadrant every 3 years. 50% coinsurance for amalgam or composite filling up to 1 per tooth every 3 years. 50% coinsurance for comprehensive oral exam, cone beam CT imaging, panoramic film up to 1 every 3 years. 50% coinsurance for crown, implant supported prosthetics up to 1 per tooth every 5 years. 50% coinsurance for bridges, complete dentures, complete or partial denture reline, partial dentures up to 1 every 5 years. 50% coinsurance for implant services, other restorative services - core buildup and prefabricated post and core up to 1 per tooth per lifetime. 50% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant per year. 50% coinsurance for periodontal debridement up to 1 per year. 50% coinsurance for pulp vitality test up to 2 per quadrant per year. 50% coinsurance for periodic oral exam, periodontal maintenance, prophylaxis (cleaning) up to 2 per year. 50% coinsurance for complete or partial denture repair up to 3 per year. 50% coinsurance for intraoral x-rays up to 6 per year. 50% coinsurance for adjustments to dentures, extractions, root canal up to unlimited per year. $1,500 combined maximum benefit coverage amount per year for adjustments to dentures, bridges, complete dentures, complete or partial denture reline, complete or partial denture repair, crown, implant services, implant supported prosthetics, other restorative services - core buildup and prefabricated post and core, partial dentures comprehensive benefits. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
Vision Benefits
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage
| Coverage | Details |
|---|---|
| Vision care | Out-of-Network: Medicare Covered Eye Exams Services: Coinsurance for Medicare Covered Eye Exams 50% Copayment for Medicare Covered Eyewear $0 |
Hearing Benefits
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing care | In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $8 Copayment for Routine Hearing Exams $0
Hearing Aids: Copayment for Hearing Aids $0
|
Preventive Services and Health/Wellness Education Programs
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | Out-of-Network: Medicare Covered Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $0 Coinsurance for Medicare Covered Medicare-covered Preventive Services 50% |
When reviewing Puerto Rico Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of Puerto Rico that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
| Links to plan documents |
Puerto Rico Counties Served
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aibonito
- Anasco
- Arecibo
- Arroyo
- Barceloneta
- Barranquitas
- Bayamon
- Cabo Rojo
- Caguas
- Camuy
- Canovanas
- Carolina
- Catano
- Cayey
- Ceiba
- Ciales
- Cidra
- Coamo
- Comerio
- Corozal
- Culebra
- Dorado
- Fajardo
- Florida
- Guanica
- Guayama
- Guayanilla
- Guaynabo
- Gurabo
- Hatillo
- Hormigueros
- Humacao
- Isabela
- Jayuya
- Juana Diaz
- Juncos
- Lajas
- Lares
- Las Marias
- Las Piedras
- Loiza
- Luquillo
- Manati
- Maricao
- Maunabo
- Mayaguez
- Moca
- Morovis
- Naguabo
- Naranjito
- Orocovis
- Patillas
- Penuelas
- Ponce
- Quebradillas
- Rincon
- Rio Grande
- Sabana Grande
- Salinas
- San German
- San Juan
- San Lorenzo
- San Sebastian
- Santa Isabel
- Toa Alta
- Toa Baja
- Trujillo Alto
- Utuado
- Vega Alta
- Vega Baja
- Vieques
- Villalba
- Yabucoa
- Yauco
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.