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MEDICARE ADVANTAGE PLANS
Select the market(s) below to view their Market HighlightsLOUISIANA
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.
LAHK7GUEN
DSNP AND VALUE PLUS PLANS
LOUISIANA
DSNP AND VALUE PLUS PLANS
PRESCRIPTION DRUG PLANS
LOUISIANA
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.
LOCAL SUPPORT
LOUISIANA
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• Flagship HMO with $0 Plan Premium, NEW
$0 PCP copay, NEW $0 RX deductible and a Reduced Specialist Copay-Large Provider Network
• Enhanced DSNP HMO Plan with Robust Supplemental Benefits for QMB, QMB+, SLMB+ and FBDE Beneficiaries-Large Provider Network
• Exclusive Ochsner ONLY Network $0 Plan Premium HMO with a Robust Benefit Structure
• Referrals to specialists not required/needed on Louisiana Humana HMO plans
• Local marketing/training support to facilitate external agent success with a convenient retail office location staffed by local leadership and available to external agents
• Local Humana Guidance Center offering health education, SilverSneakers classes, customer service support, social activities and more - open to medicare members and community
• Improved dental, hearing and OTC allowance on several plans—HMOs Include SilverSneakers, Go365 member rewards program, Nurse Advice Line, Web/Telemedicine visit benefit
• Strong Humana brand recognition throughout the Baton Rouge market
NETWORK HIGHLIGHTS• Ochsner Health System hospitals/facilities/
clinics/providers in network—New facility on Highland Road-Baton Rouge
• The Baton Rouge Clinic participates in the Humana HMO and PPO networks
• Major facilities include but not limited to: Point Coupee, OHS, Baton Rouge General, Women’s Hospital, Our Lady of the Lake, Prevost, St. Elizabeth, West Feliciana Hospital
• All PPO plans have National Network Reciprocity—members may use any Humana PPO Choice network provider in any state and services will be treated as in-network
MARKET SERVICE AREAAscension, East Baton Rouge, Livingston, West Baton Rouge
LOUISIANA BATON ROUGE
Plan Name Humana Total Care Advantage (HMO) Humana Gold Plus (HMO) Humana Gold Plus (HMO)
Plan Number H1951-039-000 H1951-048-001 H1951-030-000
Plan Highlights$0 plan premium Ochsner network only HMO plan with robust core and supplemental benefits
$0 plan premium HMO plan for beneficiaries shopping for value and robust core and supplemental benefits
$0 plan premium HMO MA only plan with dental OSB—ideal for veterans using VA for Rx and others with credible Rx coverage
Premium $0 $0 $0
PCP $0 $0 $5
Specialist $30 $35 $50
Referrals Required No No No
Inpatient Hospital $85 per day Days 1-10 $125 per day Days 1-10 $110 per day Days 1-10
Max Out-of-Pocket $3,400 In Network $3,700 In Network $6,700 In Network
Rx Deductible No Deductible No Deductible No Coverage
Rx Preferred
$0/$10/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$3/$12/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
No Coverage
Key Extra BenefitsDental, Vision, Hearing, Fitness, OTC allowance $30/Quarter, Transportation
Dental, Vision, Hearing, Fitness, OTC allowance $50/Quarter
Vision, Hearing, Fitness, OTC allowance $30/Quarter
Market Service Area East Baton Rouge, Livingston, West Baton Rouge Baton Rouge Marketwide Baton Rouge Marketwide
LOUISIANA | BATON ROUGE MA/MAPD PLANS
Plan Name HumanaChoice (Regional PPO)
Plan Number R0110-001-000
Plan Highlights$0 plan premium MA only RPPO with $40 Part B premium giveback; great option for the veteran population
Premium $0
PCP $0
Specialist $35
Referrals Required No
Inpatient Hospital $195 per day Days 1-6
Max Out-of-Pocket $6,700 In Network
Rx Deductible No Coverage
Rx Preferred No Coverage
Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $30/Quarter
Market Service Area Statewide in Louisiana, Mississippi
LOUISIANA | BATON ROUGE MA/MAPD PLANS
MEDICARE ADVANTAGE PLANS
MARKET HIGHLIGHTS• Flagship HMO with new $0 plan premium, new
$0 PCP copay, new $0 RX deductible and a reduced specialist copay-large provider network
• Enhanced DSNP HMO Plan with Loaded Supplemental Benefits for QMB, QMB+, SLMB+ and FBDE Beneficiaries-Large Provider Network
• Exclusive Ochsner ONLY Network $0 Plan Premium HMO with a Robust Benefit Structure
• REFERRALS to Specialists NOT Required/Needed on Louisiana Humana HMO Plans
• Local Marketing/Training Support to Facilitate External Agent Success with a Convenient Retail Office Location staffed by Local Leadership and Available to External Agents
• Local Humana Guidance Center offering Health Education, SilverSneakers Classes, Customer Service Support, Social Activities & much more-Open to Medicare Members and Community
• HMOs have Improved Dental, Hearing and OTC Allowance—Also Included are SilverSneakers, Go365 Member Rewards Program, Nurse Advice Line and a Web/Telemedicine Visit Benefit
• Strong Humana Brand Recognition Throughout the Baton Rouge Market
NETWORK HIGHLIGHTS• Ochsner Health System Hospitals/Facilities/
Clinics/Providers IN-Network—New Facility on Highland Road Baton Rouge
• The Baton Rouge Clinic participates in the Humana HMO and PPO Networks
• Major Facilities Include but not Limited to: Point Coupee, OHS, Baton Rouge General, Woman’s Hospital, Our Lady of the Lake, Prevost, St. Elizabeth, West Feliciana Hospital
• All PPO Plans have National Network Reciprocity—Member may use any Humana PPO Choice Network Provider in Any State and Services will be Treated as IN-NETWORK
MARKET SERVICE AREAEast Feliciana, Iberville, Pointe Coupee, Saint Helena, West Feliciana
LOUISIANA BATON ROUGE NORTH
Plan Name Humana Total Care Advantage (HMO) Humana Gold Plus (HMO) Humana Gold Plus (HMO)
Plan Number H1951-039-000 H1951-048-002 H1951-030-000
Plan Highlights$0 plan premium Ochsner network ONLY HMO plan with Robust Core and Supplemental Benefits
$0 plan premium HMO plan for Beneficiaries Shopping for Value and Robust Core and Supplemental Benefits
$0 plan premium HMO MA Only plan with dental OSB-Ideal for veterans using VA for Rx and Others with Credible Rx coverage
Premium $0 $0 $0
PCP $0 $0 $5
Specialist $30 $40 $50
Referrals Required No No No
Inpatient Hospital $85 per day Days 1-10 $125 per day Days 1-10 $110 per day Days 1-10
Max Out-of-Pocket $3,400 In Network $6,700 In Network $6,700 In Network
Rx Deductible No Deductible No Deductible No Coverage
Rx Preferred
$0/$10/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$3/$12/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
No Coverage
Key Extra BenefitsDental, Vision, Hearing, Fitness, OTC allowance $30/Quarter, Transportation
Dental, Vision, Hearing, Fitness, OTC allowance $30/Quarter
Vision, Hearing, Fitness, OTC allowance $30/Quarter
Market Service Area East Feliciana, Iberville, Saint Helena Baton Rouge North Marketwide Baton Rouge North Marketwide
LOUISIANA | BATON ROUGE NORTH MA/MAPD PLANS
Plan Name HumanaChoice (Regional PPO)
Plan Number R0110-001-000
Plan Highlights$0 plan premium MA Only RPPO with $40 Part B premium giveback; Great option for the veteran population
Premium $0
PCP $0
Specialist $35
Referrals Required No
Inpatient Hospital $195 per day Days 1-6
Max Out-of-Pocket $6,700 In Network
Rx Deductible No Coverage
Rx Preferred No Coverage
Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $30/Quarter
Market Service Area Statewide in Louisiana, Mississippi
LOUISIANA | BATON ROUGE NORTH MA/MAPD PLANS
MEDICARE ADVANTAGE PLANS
MARKET HIGHLIGHTS• Flagship HMO with $22 Plan Premium, NEW $5
PCP Copay, NEW $0 Rx Deductible with a Large Provider Network
• Enhanced DSNP HMO with Loaded Supplemental Benefits for QMB, QMB+, SLMB+ and FBDE Beneficiaries-Large Provider Network
• REFERRALS to Specialists NOT Required/Needed on Louisiana Humana HMO Plans
• Improved Dental—HMOs includes Vision, Hearing, SilverSneakers, OTC Allowance, Go365 Member Rewards Program, Nurse Advice Line and a Web/Telemedicine Visit Benefit
• Local Marketing/Training Support to Facilitate External Agent Success-Metairie Retail Office Location Staffed by Local Leadership and Available to External Agents
• Strong Humana Brand Recognition Throughout the Market
• Humana Owned Mail Order Pharmacy—$0 Rx Copay (90-Day Supply) Tier 1 & 2—All MAPD Plans
• Humana Metairie Guidance Center offering Health Education, SilverSneakers Classes, Customer Service Support, Social Activities & more—Open to Medicare Members and Community
NETWORK HIGHLIGHTS• Ochsner Health System Hospitals/Facilities/
Clinics/Providers IN-Network - New Facility on Highland Road Baton Rouge
• IN-Network providers include but not limited to: Family Doctor Clinic (Thibodaux), Haydel Clinic, Family Doctor (Houma)
• Major Facilities Include but not limited to: Terrebone General, Thibodaux Regional, Ochsner St. Anne, Lady of the Sea General
• All PPO Plans have National Network Reciprocity - Member may use any Humana PPO Choice Network Provider in Any State and Services will be Treated as IN-NETWORK
MARKET SERVICE AREAAssumption, Lafourche, Plaquemines, Saint James, St John The Baptist, Terrebonne
LOUISIANA BAYOU & RIVER PARISHES
Plan Name Humana Gold Plus (HMO) HumanaChoice (Regional PPO) HumanaChoice (Regional PPO)
Plan Number H1951-047-002 R0110-002-000 R0110-003-000
Plan Highlights$22 plan premium HMO plan for Beneficiaries Shopping for Value and Robust Core and Supplemental Benefits
$53 plan premium PPO plan with dental OSB, Statewide network with choice, Includes national network reciprocity
$87 plan premium PPO plan-dental/vision OSBs-Statewide network with choice-Includes national network reciprocity
Premium $22 $53 $87
PCP $5 $15 $15
Specialist $50 $50 $50
Referrals Required No No No
Inpatient Hospital $150 per day Days 1-10 $275 per day Days 1-7 $275 per day Days 1-7
Max Out-of-Pocket $6,700 In Network $6,700 In Network $6,700 In Network
Rx Deductible No Deductible $415 tiers 3-5 $400 tiers 4-5
Rx Preferred
$3/$12/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$2/$14/$47/$100/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$6/$15/$47/$99/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
Key Extra BenefitsDental, Vision, Hearing, Fitness, OTC allowance $30/Quarter, Transportation
Vision, Hearing, Fitness, OTC allowance $25/Quarter
Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter
Market Service Area Bayou & River Parishes Marketwide Statewide in Louisiana, Mississippi Statewide in Louisiana, Mississippi
LOUISIANA | BAYOU & RIVER PARISHES MA/MAPD PLANS
Plan Name HumanaChoice (Regional PPO)
Plan Number R0110-001-000
Plan Highlights$0 plan premium MA Only RPPO with $40 Part B premium giveback; Great option for the veteran population
Premium $0
PCP $0
Specialist $35
Referrals Required No
Inpatient Hospital $195 per day Days 1-6
Max Out-of-Pocket $6,700 In Network
Rx Deductible No Coverage
Rx Preferred No Coverage
Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $30/Quarter
Market Service Area Statewide in Louisiana, Mississippi
LOUISIANA | BAYOU & RIVER PARISHES MA/MAPD PLANS
MEDICARE ADVANTAGE PLANS
MARKET HIGHLIGHTS• Flagship $0 Plan Premium HMO with NEW $0
RX Deductible and Lowered PCP and Specialist Copays-Large Provider Network
• Enhanced DSNP HMO with Loaded Supplemental Benefits for QMB, QMB+, SLMB+ and FBDE Beneficiaries—Large Provider Network
• REFERRALS to Specialists NOT Required/Needed on Louisiana Humana HMO Plans
• Improved Dental—HMO Includes Vision, Hearing, SilverSneakers, OTC Allowance, Go365 Member Rewards Program, 24/7 Nurse Advice Line and a Web/Telemedicine Visit Benefit
• Strong Humana Brand in the Monroe Market
• Humana Market Manager Highly Engaged with External Agents/Partners
• Humana Owned Mail Order Pharmacy—$0 Rx Copay (90-Day Supply) Tier 1 & 2—All MAPD Plans
• Robust Compliment of PPO Products including a NEW $40 Part B Premium Giveback on MA Only PPO Plan, good fit for veterans
NETWORK HIGHLIGHTS• Major Facilities Include but not limited to:
St. Francis, Glenwood Regional, University Health, Monroe Surgical, P&S Surgical, Richardson Medical, Moorehouse & Union General
• Robust Network of Primary Care including Physician Group of Louisiana, Northeast Louisiana Health Center and More
• Collaborative Relationships with Network Providers
• ALL PPO Plans have National Network Reciprocity—Member may use any Humana PPO Choice Network Provider in Any State and Services will be Treated as IN-NETWORK
MARKET SERVICE AREACaldwell, Catahoula, East Carroll, Franklin, Jackson, Lincoln, Madison, Morehouse, Ouachita, Richland, Tensas, Union, West Carroll
LOUISIANA MONROE
Plan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (Regional PPO)
Plan Number H1951-049-003 H5216-064-000 R0110-002-000
Plan Highlights$0 plan premium HMO plan for Beneficiaries Shopping for Value and Robust Core and Supplemental Benefits
$45 plan premium LPPO plan with broader network & national network reciprocity using the Humana Choice network
$53 plan premium PPO plan with dental OSB, Statewide network with choice, Includes national network reciprocity
Premium $0 $45 $53
PCP $10 $5 $15
Specialist $40 $45 $50
Referrals Required No No No
Inpatient Hospital $215 per day Days 1-8 $225 per day Days 1-7 $275 per day Days 1-7
Max Out-of-Pocket $6,700 In Network $6,700 In Network $6,700 In Network
Rx Deductible No Deductible $400 tiers 4-5 $415 tiers 3-5
Rx Preferred
$6/$9/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$5/$15/$47/$99/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$2/$14/$47/$100/25%; $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 $45/Quarter
Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter
Vision, Hearing, Fitness, OTC allowance $25/Quarter
Market Service Area Monroe Marketwide Caldwell, Morehouse, Ouachita Statewide in Louisiana, Mississippi
LOUISIANA | MONROE MA/MAPD PLANS
Plan Name HumanaChoice (Regional PPO)
Plan Number R0110-001-000
Plan Highlights$0 plan premium MA Only RPPO with $40 Part B premium giveback; Great option for the veteran population
Premium $0
PCP $0
Specialist $35
Referrals Required No
Inpatient Hospital $195 per day Days 1-6
Max Out-of-Pocket $6,700 In Network
Rx Deductible No Coverage
Rx Preferred No Coverage
Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $30/Quarter
Market Service Area Statewide in Louisiana, Mississippi
LOUISIANA | MONROE MA/MAPD PLANS
MEDICARE ADVANTAGE PLANS
MARKET HIGHLIGHTS• Flagship $0 Plan Premium HMO with $0 PCP
Copay, NEW $0 Rx Deductible, NEW $3,700 MOOP and a Robust Provider Network
• Enhanced DSNP HMO with Loaded Supplemental Benefits for QMB, QMB+, SLMB+ and FBDE Beneficiaries-Large Provider Network
• Unique $0 Plan Premium Chronic-Condition SNP Plan (Diabetes, Congestive Heart Failure, Cardiovascular Disease) with Year-Round SEP Sales Opportunity and Robust Benefits
• Exclusive Ochsner ONLY Network $0 Plan Premium HMO with Robust Benefit Structure
• REFERRALS to Specialists NOT Required/Needed on Louisiana Humana HMO Plans
• Local Humana Guidance Center offering Health Education, SilverSneakers Classes, Customer Service Support, Social Activities & much more-Open to Medicare Members and Community
• Local Marketing/Training Support to Facilitate External Agent Success-Convenient Retail Office Location Staffed by Local Leadership and Available to External Agents
• Strong Humana Brand Recognition Throughout the New Orleans Market
NETWORK HIGHLIGHTS• Ochsner Health System Hospitals/Facilities/
Clinics/Providers IN-Network
• Major Facilities Include but not limited to: East Jefferson, West Jefferson, Touro, Womans, Tulane, St. Theresa, Ochsner Baptist, Lakeside, N.O. East, St. Charles Hospital
• Collaborative Relationships with Network Providers
• All PPO Plans have National Network Reciprocity - Members may use any Humana PPO Choice Network Provider in Any State and services will be treated as IN-NETWORK
MARKET SERVICE AREAJefferson, Orleans, Saint Bernard, Saint Charles
LOUISIANA NEW ORLEANS
Plan Name Humana Total Care Advantage (HMO) Humana Gold Plus (HMO) Humana Gold Plus - Diabetes and
Heart (HMO SNP)
Plan Number H1951-038-000 H1951-047-001 H1951-044-000
Plan Highlights$0 plan premium Ochsner ONLY network HMO plan with Robust Core and Supplemental Benefits
$0 plan premium HMO plan for Beneficiaries Shopping for Value and Robust Core and Supplemental Benefits
$0 plan premium Chronic Special Needs plan for Cardiovascular Disorders, Congestive Heart Failure, and Diabetes Mellitus
Premium $0 $0 $0
PCP $0 $0 $0
Specialist $25 $35 $25
Referrals Required No No No
Inpatient Hospital $75 per day Days 1-10 $85 per day Days 1-10 $25 per day Days 1-5
Max Out-of-Pocket $3,400 In Network $3,700 In Network $3,400 In Network
Rx Deductible No Deductible No Deductible No Deductible
Rx Preferred
$0/$10/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$3/$12/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$0/$4/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
Key Extra BenefitsDental, Vision, Hearing, Fitness, OTC allowance $45/Quarter, Transportation
Dental, Vision, Hearing, Fitness, OTC allowance $30/Quarter, Transportation
Dental, Vision, Hearing, Fitness, OTC allowance $20/Month, Transportation
Market Service Area Jefferson, Orleans, Saint Charles Jefferson, Orleans, Saint Charles Jefferson, Orleans
LOUISIANA | NEW ORLEANS MA/MAPD PLANS
Plan Name HumanaChoice (PPO)
Plan Number H5216-064-000
Plan Highlights$45 plan premium LPPO plan with broader network & national network reciprocity using the Humana Choice network
Premium $45
PCP $5
Specialist $45
Referrals Required No
Inpatient Hospital $225 per day Days 1-7
Max Out-of-Pocket $6,700 In Network
Rx Deductible $400 tiers 4-5
Rx Preferred
$5/$15/$47/$99/25%; $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 $25/Quarter
Market Service Area Saint Bernard
LOUISIANA | NEW ORLEANS MA/MAPD PLANS
MEDICARE ADVANTAGE PLANS
MARKET HIGHLIGHTS• Enhanced DSNP HMO with Loaded
Supplemental Benefits for QMB, QMB+, SLMB+ and FBDE Beneficiaries-Large Provider Network
• REFERRALS to Specialists NOT Required/Needed on Louisiana Humana HMO Plans
• Local Marketing/Training Support to Facilitate External Agent Success with a Humana Sales Manager located in the Area
• Improved Dental Benefit-HMO also includes Vision, Hearing, SilverSneakers, OTC Allowance, Go365 Member Rewards Program, Nurse Advice Line and a Web/Telemedicine Visit Benefit
• Strong Humana Brand Recognition Throughout the North Shore Market
• Collaborative Physician Relationships and Highly Engaged Humana Network Support Team
• Humana Owned Mail Order Pharmacy—$0 Rx Copay (90-Day Supply) Tier 1 & 2—All MAPD Plans
• NEW $40 Part B Premium Giveback on the PPO MA Only Plan - Ideal for veterans Using VA for Drug Coverage and Other Beneficiaries with Credible Drug Coverage
NETWORK HIGHLIGHTS• Ochsner Health System Hospitals/Facilities/
Clinics/Providers IN-Network
• Major Facilities Include but not Limited to: Slidell Memorial, St. Tammany Parish, Lakeview, Fairway and Riverside Medical, Southern Surgical, Our Lady of Angels
• Collaborative Relationships with Network Providers
• All PPO Plans have National Network Reciprocity—Member May use any Humana PPO Choice Network Provider in Any State and services will be treated as IN-NETWORK
MARKET SERVICE AREASaint Tammany, Washington
LOUISIANA NORTH SHORE
Plan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (Regional PPO)
Plan Number H1951-028-000 H5216-064-000 R0110-002-000
Plan Highlights$26 plan premium HMO for Beneficiaries Shopping for Value and Robust Supplemental Benefits
$45 plan premium LPPO plan with broader network & national network reciprocity using the Humana Choice network
$53 plan premium PPO plan with dental OSB, Statewide network with choice, Includes national network reciprocity
Premium $26 $45 $53
PCP $10 $5 $15
Specialist $45 $45 $50
Referrals Required No No No
Inpatient Hospital $195 per day Days 1-10 $225 per day Days 1-7 $275 per day Days 1-7
Max Out-of-Pocket $6,700 In Network $6,700 In Network $6,700 In Network
Rx Deductible $400 tiers 4-5 $400 tiers 4-5 $415 tiers 3-5
Rx Preferred
$7/$12/$47/$99/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$5/$15/$47/$99/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$2/$14/$47/$100/25%; $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 $30/Quarter
Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter
Vision, Hearing, Fitness, OTC allowance $25/Quarter
Market Service Area North Shore Marketwide Washington Statewide in Louisiana, Mississippi
LOUISIANA | NORTH SHORE MA/MAPD PLANS
Plan Name HumanaChoice (Regional PPO)
Plan Number R0110-001-000
Plan Highlights$0 plan premium MA Only RPPO with $40 Part B premium giveback; Great option for the veteran population
Premium $0
PCP $0
Specialist $35
Referrals Required No
Inpatient Hospital $195 per day Days 1-6
Max Out-of-Pocket $6,700 In Network
Rx Deductible No Coverage
Rx Preferred No Coverage
Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $30/Quarter
Market Service Area Statewide in Louisiana, Mississippi
LOUISIANA | NORTH SHORE MA/MAPD PLANS
MEDICARE ADVANTAGE PLANS
MARKET HIGHLIGHTS• Flagship HMO with NEW $0 Plan Premium, NEW
$0 Rx Deductible and a Robust Provider Network • Enhanced DSNP HMO with Loaded
Supplemental Benefits for QMB, QMB+, SLMB+ and FBDE Beneficiaries-Large Provider Network
• REFERRALS to Specialists NOT Required/Needed on Louisiana Humana HMO Plans
• Local Marketing/Training Support to Facilitate External Agent Success. Convenient Retail Office Location Staffed by Market Leadership and Available to our External Agents
• NEW Humana Guidance Center LITE offering Health Education, SilverSneakers Classes, Customer Service Kiosk, Social Activities and more—Open to Medicare Members & Community
• Improved Dental, Vision—HMO Includes Hearing, SilverSneakers, OTC Allowance, Go365 Member Rewards Program, 24/7 Nurse Advice Line and a Web/Telemedicine Visit Benefit
• Strong Humana Brand Recognition Throughout the Shreveport-Bossier City Market
• NEW $40 Part B Premium Giveback on the PPO MA Only Plan—Ideal for veterans Using VA for Drug Coverage and Other Beneficiaries with Credible Drug Coverage
NETWORK HIGHLIGHTS• Major Facilities Include but not Limited to:
Willis-Knighton Health, Christus Health, Specialist Hospital Shreveport, University Health Shreveport, Minden, North Caddo
• Solid Compliment of Primary and Specialty Care Network Providers
• ALL PPO Plans have National Network Reciprocity—Member May use any Humana PPO Choice Network Provider in Any State and services will be treated as IN-NETWORK
• Collaborative Relationships with Network Providers
MARKET SERVICE AREABienville, Bossier, Caddo, Claiborne, DeSoto, Red River, Sabine, Webster
LOUISIANA SHREVEPORT - BOSSIER CITY
Plan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (Regional PPO)
Plan Number H1951-013-000 H5525-015-000 R0110-002-000
Plan HighlightsFlagship $0 plan premium HMO plan for Beneficiaries Shopping for Value and Robust Core and Supplemental Benefits
$45 Plan Premium LPPO Plan with a Broad Network & National Network Reciprocity using the Humana Choice Network
$53 plan premium PPO plan with dental OSB, Statewide network with choice, Includes national network reciprocity
Premium $0 $45 $53
PCP $5 $5 $15
Specialist $40 $45 $50
Referrals Required No No No
Inpatient Hospital $195 per day Days 1-7 $225 per day Days 1-7 $275 per day Days 1-7
Max Out-of-Pocket $6,700 In Network $6,700 In Network $6,700 In Network
Rx Deductible No Deductible $400 tiers 4-5 $415 tiers 3-5
Rx Preferred
$6/$15/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$5/$15/$47/$99/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$2/$14/$47/$100/25%; $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 $50/Quarter
Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter
Vision, Hearing, Fitness, OTC allowance $25/Quarter
Market Service Area Bossier, Caddo, Webster Bienville, Claiborne, DeSoto, Red River, Sabine Statewide in Louisiana, Mississippi
LOUISIANA | SHREVEPORT - BOSSIER CITY MA/MAPD PLANS
Plan Name HumanaChoice (Regional PPO)
Plan Number R0110-001-000
Plan Highlights$0 plan premium MA Only RPPO with $40 Part B premium giveback; Great option for the veteran population
Premium $0
PCP $0
Specialist $35
Referrals Required No
Inpatient Hospital $195 per day Days 1-6
Max Out-of-Pocket $6,700 In Network
Rx Deductible No Coverage
Rx Preferred No Coverage
Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $30/Quarter
Market Service Area Statewide in Louisiana, Mississippi
LOUISIANA | SHREVEPORT - BOSSIER CITY MA/MAPD PLANS
MEDICARE ADVANTAGE PLANS
MARKET HIGHLIGHTS• Flagship $0 Plan Premium HMO Plans for the
Lafayette, Lake Charles, Alexandria Area with a NEW $0 Rx Deductible and Low PCP and Specialist Copays
• Enhanced DSNP HMO with Loaded Supplemental Benefits for QMB, QMB+, SLMB+ and FBDE Beneficiaries-Large Provider Network
• REFERRALS to Specialists NOT Required/Needed on Louisiana Humana HMO Plans
• Local Marketing/Training Support to Facilitate External Agent Success. Convenient Retail Office Location Staffed by Market Leadership and Available to our External Agents
• Humana Guidance Center LITE offering Health Education, SilverSneakers Classes, Customer Service Kiosk, Social Activities and more—Open to Medicare Members and Community
• Improved Dental—HMOs Include Vision, Hearing, SilverSneakers, OTC Allowance, Go365 Member Rewards Program, Nurse Advice Line and a Web/Telemedicine Visit Benefit
• Strong Humana Brand Recognition Throughout the South West Central Market
• NEW $40 Part B Premium Giveback on the PPO MA Only Plan—Ideal for veterans Using VA for Drug Coverage and Other Beneficiaries with Credible Drug Coverage
NETWORK HIGHLIGHTS• Major Facilities Include but not Limited to:
Lake Charles Memorial, Lafayette General, Rapides General, Christus St. Patrick System, West Cal-Cam Hospital, Opelousas General
• Major Clinic participation include but not limited to: SWLA Community Care Clinic, Iberia Comprehensive Clinic, Teche Action Clinic, Cardiovascular Institute of the South
• Collaborative Relationships with Network Providers
• All PPO Plans have National Network Reciprocity—Member may use any Humana PPO Choice Network Provider in Any State and Services will be Treated as IN-NETWORK
MARKET SERVICE AREAAcadia, Allen, Avoyelles, Beauregard, Calcasieu, Cameron, Concordia, Evangeline, Grant, Iberia, Jefferson Davis, La Salle, Lafayette, Natchitoches, Rapides, Saint Landry, Saint Martin, Saint Mary, Vermilion, Vernon, Winn
LOUISIANA SOUTH WEST CENTRAL
Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO)
Plan Number H1951-049-001 H1951-049-002 H5216-064-000
Plan HighlightsFlagship $0 plan premium HMO for Beneficiaries Shopping for Value and Robust Core and Supplemental Benefits
Flagship $0 plan premium HMO for Beneficiaries Shopping for Value and Robust Core and Supplemental Benefits
$45 plan premium LPPO plan with broader network & national network reciprocity using the Humana Choice network
Premium $0 $0 $45
PCP $10 $0 $5
Specialist $35 $35 $45
Referrals Required No No No
Inpatient Hospital $195 per day Days 1-8 $195 per day Days 1-8 $225 per day Days 1-7
Max Out-of-Pocket $6,700 In Network $6,700 In Network $6,700 In Network
Rx Deductible No Deductible No Deductible $400 tiers 4-5
Rx Preferred
$6/$9/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$6/$9/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$5/$15/$47/$99/25%; $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 $45/Quarter
Dental, Vision, Hearing, Fitness, OTC allowance $45/Quarter
Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter
Market Service Area Calcasieu, Cameron, Grant, Rapides Acadia, Iberia, Lafayette, Saint Landry, Saint Martin, Vermilion
Calcasieu, Cameron, La Salle, Lafayette, Saint Landry, Saint Martin, Saint Mary
LOUISIANA | SOUTH WEST CENTRAL MA/MAPD PLANS
Plan Name HumanaChoice (PPO) HumanaChoice (PPO)
Plan Number H5216-135-000 H5525-015-000
Plan Highlights
$45 Plan Premium LPPO Plan with a Broad Network & National Network Reciprocity using the Humana Choice Network
$45 Plan Premium LPPO Plan with a Broad Network & National Network Reciprocity using the Humana Choice Network
Premium $45 $45
PCP $5 $5
Specialist $45 $45
Referrals Required No No
Inpatient Hospital $225 per day Days 1-7 $225 per day Days 1-7
Max Out-of-Pocket $6,700 In Network $6,700 In Network
Rx Deductible $400 tiers 4-5 $400 tiers 4-5
Rx Preferred
$5/$15/$47/$99/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$5/$15/$47/$99/25%; $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 $25/Quarter
Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter
Market Service Area Allen, Avoyelles, Beauregard, Evangeline, Jefferson Davis, Vernon Natchitoches, Winn
LOUISIANA | SOUTH WEST CENTRAL MA/MAPD PLANS
MEDICARE ADVANTAGE PLANS
MARKET HIGHLIGHTS• Enhanced DSNP HMO with Loaded
Supplemental Benefits for QMB, QMB+, SLMB+ and FBDE Beneficiaries—Large Provider Network
• REFERRALS to Specialists NOT Required/Needed on Louisiana Humana HMO Plans
• Local Marketing/Training Support to Facilitate External Agent Success with a Humana Sales Manager Located in the Area
• CORE & DSNP HMO plans include Dental, Vision, Hearing, SilverSneakers , OTC Allowance, Go365 Member Rewards Program, Nurse Advice Line and a Web/Telemedicine Visit Benefit
• Strong Humana Brand Recognition Throughout the Market
• Collaborative Physician Relationships and a Highly Engaged Humana Network Support Team
• Humana Owned Mail Order Pharmacy—$0 Rx Copay (90-Day Supply) Tier 1 & 2-All MAPD Plans
• NEW $40 Part B Premium Giveback PPO MA Only Plan—Ideal for veterans Using VA for Drug Coverage and Other Beneficiaries with Credible Drug Coverage
NETWORK HIGHLIGHTS• Ochsner Health System Hospitals/Facilities/
Clinics/Providers IN-Network
• Major Facilities Include but not Limited to: North Oaks, Cypress Point Surgical, LSU Lallie Kemp, St. Tammany Parish, Lakeview, Fairway Medical, Woman’s Hospital Baton Rouge
• Solid Compliment of Primary and Specialty Care Network Providers
• All PPO Plans have National Network Reciprocity—Member may use any Humana PPO Choice Network Provider in Any State and services will be treated as IN-NETWORK
MARKET SERVICE AREATangipahoa
LOUISIANA TANGIPAHOA PARISH
Plan Name Humana Gold Plus (HMO) HumanaChoice (Regional PPO) HumanaChoice (Regional PPO)
Plan Number H1951-024-000 R0110-002-000 R0110-003-000
Plan Highlights$59 plan premium HMO for Beneficiaries Shopping for network choice—NO referral requirement to see Specialists
$53 plan premium PPO plan with dental OSB, Statewide network with choice, Includes national network reciprocity
$87 plan premium PPO plan—dental/vision OSBs—Statewide network with choice-Includes national network reciprocity
Premium $59 $53 $87
PCP $0 $15 $15
Specialist $35 $50 $50
Referrals Required No No No
Inpatient Hospital $200 per day Days 1-7 at preferred facility $275 per day Days 1-7 $275 per day Days 1-7
Max Out-of-Pocket $6,700 In Network $6,700 In Network $6,700 In Network
Rx Deductible No Deductible $415 tiers 3-5 $400 tiers 4-5
Rx Preferred
$3/$12/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$2/$14/$47/$100/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy
$6/$15/$47/$99/25%; $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 $30/Quarter
Vision, Hearing, Fitness, OTC allowance $25/Quarter
Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter
Market Service Area Tangipahoa Parish Marketwide Statewide in Louisiana, Mississippi Statewide in Louisiana, Mississippi
LOUISIANA | TANGIPAHOA PARISH MA/MAPD PLANS
Plan Name HumanaChoice (Regional PPO)
Plan Number R0110-001-000
Plan Highlights$0 plan premium MA Only RPPO with $40 Part B premium giveback; Great option for the veteran population
Premium $0
PCP $0
Specialist $35
Referrals Required No
Inpatient Hospital $195 per day Days 1-6
Max Out-of-Pocket $6,700 In Network
Rx Deductible No Coverage
Rx Preferred No Coverage
Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $30/Quarter
Market Service Area Statewide in Louisiana, Mississippi
LOUISIANA | TANGIPAHOA PARISH MA/MAPD PLANS
LOUISIANA
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
LOUISIANA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW
Plan Name Humana Gold Plus SNP-DE (HMO SNP)Plan Number H1951-041-000
Plan Highlights Dual-Eligible Special Needs HMO plan for QMB, QMB+, SLMB+ and FBDE with Loaded Supplemental Benefits
Dental $2,500 annually; $0 copayment covers: exams, x-rays, cleanings, fillings, crowns, extractions, dentures
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 AreaAcadia, Bossier, Caddo, Calcasieu, Caldwell, Cameron, Catahoula, East Carroll, Franklin, Grant, Iberia, Jackson, Lafayette, Lincoln, Madison, Morehouse, Ouachita, Rapides, Richland, Saint Landry, Saint Martin, Tangipahoa, Tensas, Union, Vermilion, Webster, West Carroll
LOUISIANA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW
Plan Name Humana Gold Plus SNP-DE (HMO SNP)Plan Number H1951-032-000
Plan Highlights Dual-Eligible Special Needs HMO plan for QMB, QMB+, SLMB+ and FBDE with Loaded Supplemental Benefits
Dental $2,500 annually; $0 copayment covers: exams, x-rays, cleanings, fillings, crowns, extractions, dentures
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 Area Ascension, East Baton Rouge, East Feliciana, Iberville, Livingston, Pointe Coupee, Saint Helena, West Baton Rouge, West Feliciana
LOUISIANA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW
Plan Name Humana Gold Plus SNP-DE (HMO SNP)Plan Number H1951-033-000
Plan Highlights Dual-Eligible Special Needs HMO plan for QMB, QMB+, SLMB+ and FBDE with Loaded Supplemental Benefits
Dental $2,500 annually; $0 copayment covers: exams, x-rays, cleanings, fillings, crowns, extractions, dentures
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 Area Assumption, Jefferson, Lafourche, Orleans, Plaquemines, Saint Charles, Saint James, St John The Baptist, Terrebonne
LOUISIANA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW
Plan Name Humana Gold Plus SNP-DE (HMO SNP)Plan Number H1951-034-000
Plan Highlights Dual-Eligible Special Needs HMO plan for QMB, QMB+, SLMB+ and FBDE with Loaded Supplemental Benefits
Dental $2,500 annually; $0 copayment covers: exams, x-rays, cleanings, fillings, crowns, extractions, dentures
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 Area Saint Tammany, Washington
LOUISIANA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW
NEW
Plan Name Humana Value Plus (PPO)Plan Number H5525-037-000
Plan Highlights Lean medical and Rx benefits with rich supplemental benefits, designed with dual eligibles in mind yet available to all
Dental $2,000 annually; $0 copayment covers: exams, x-rays, cleanings, fillings, crowns, extractions, dentures
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 In network: Annual exam and fitting plus $1,000 credit for hearing aids once every 3 years. Out of network: 25% coinsurance for annual exam and fitting plus $1,000 credit for hearing aids once every 3 years
OTC Allowance OTC $150/Quarter for select health and wellness products
Transportation Up to 24 one-way trips to approved locations and fitness centers per year
Current Service Area Bienville, Claiborne, De Soto, Natchitoches, Red River, Sabine, Winn
LOUISIANA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW
NEW
Plan Name Humana Value Plus (PPO)Plan Number H5216-161-000
Plan Highlights Lean medical and Rx benefits with rich supplemental benefits, designed with dual eligibles in mind yet available to all
Dental $2,000 annually; $0 copayment covers: exams, x-rays, cleanings, fillings, crowns, extractions, dentures
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 In network: Annual exam and fitting plus $1,000 credit for hearing aids once every 3 years. Out of network: 25% coinsurance for annual exam and fitting plus $1,000 credit for hearing aids once every 3 years
OTC Allowance OTC $150/Quarter for select health and wellness products
Transportation Up to 24 one-way trips to approved locations and fitness centers per year
Current Service Area Allen, Avoyelles, Beauregard, Evangeline, Jefferson Davis, La Salle, Saint Bernard, Saint Mary, Vernon
Plan Name Humana Preferred Rx Plan (PDP) Humana Walmart Rx Plan (PDP)
Plan Number S5884-108-000 S5884-167-000
Plan HighlightsPairs well for members with Extra Help (LIS). Tier 1 & Tier 2 mail-order copays are $0 at Humana Pharmacy for 90-day supply.
Retail copays as low as $1. Tier 1 mail-order copays are as low as $0 at Humana Pharmacy for 90-day supply.
Premium TBD TBD
Rx Deductible $415 all tiers $415 tiers 3-5
Preferred Retail 30-day Supply No Coverage $1/$4/20%/35%/25%
Standard Retail 30-day Supply $0/$1/25%/36%/25% $10/$20/25%/50%/25%
Preferred Mail 90-day Supply $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2
Market Service Area Louisiana Statewide Louisiana Statewide
LOUISIANA PDP PLANS
LOCAL SUPPORT
LOUISIANA
Local Market Office(504) 667-4366
Tiffany McGuireBroker Relationship Manager (504) [email protected]
Gary ChinBroker Relationship Executive(855) [email protected]