Page 82 - Cover Letter and Evaluation for Amy Prack

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Your Plan Details

Zip Code: 43221
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs Drug List ID: 3233662560
and more coverage and star ratings.
Password Date: 05/12/2019
Important Coverage Information

Symbols
A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment
will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the
enrollee is not responsible for obtaining (prior) authorization.
Some Dental Coverage Some Vision Coverage

* Estimated

HumanaChoice H5525-042 500 West Main Street Overall Star Rating: Enroll
(PPO) Louisville, KY 40202 Members: [?]
1-800-457-4708 711 (TTY/TDD)
(H5525-042-0) 1 Non Members: 1-800-833-2364 4 out of 5 stars
711 (TTY/TDD)
Organization: Humana
Plan Type: Local Preferred
Provider Organization

Additional Plan Information

Overall Star Rating [?] 4 out of 5 stars

Health Plan Star Ratings [?] 3.5 out of 5 stars

Drug Plan Star Ratings [?] 4.5 out of 5 stars

Plan Type: Local Preferred Provider Organization
Plan Status: Approved by Medicare
Area: Select counties in Ohio

View plan website 
Important Note:
This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.

View Drug Benefit Summary