Page 28 - APPENDICES for Diane Falten
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HumanaChoice H5216-138 (PPO)
Humana | Plan ID: H5216-138-0
Star rating:
MONTHLY PREMIUM
$0.00 Includes: Health & drug coverage
Doesn't include: $148.50 Standard Part B premium
YEARLY DRUG & PREMIUM COST
$276.00 Retail pharmacy: Estimated total drug + premium cost
Doesn't include: Health costs
OTHER COSTS
$375 annual deductible Health deductible
$275.00 Drug deductible
$7,550 In and Out-of-network Maximum you pay for health services
$4,800 In-network
Aetna Medicare Elite Plan (HMO)
Aetna Medicare | Plan ID: H5793-015-0
Star rating:
MONTHLY PREMIUM
$0.00 Includes: Health & drug coverage
Doesn't include: $148.50 Standard Part B premium
YEARLY DRUG & PREMIUM COST
$286.08 Retail pharmacy: Estimated total drug + premium cost
Doesn't include: Health costs
