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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

Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter

Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter

Market Service Area Joplin Marketwide Joplin Marketwide Barry, Lawrence

MISSOURI | JOPLIN MA/MAPD PLANS

NEW

Plan Name HumanaChoice (PPO) HumanaChoice (PPO) HumanaChoice (Regional PPO)

Plan Number H5216-163-000 H5216-032-000 R1532-002-000

Plan Highlights$35 plan premium LPPO MAPD, SilverSneakers, vision, hearing and more

KS-MO High Option LPPOStatewide RPPO MAPD Arkansas and Missouri. Not commissionable in LPPO service area

Premium $35 $83 $109

PCP $10 $20 $20

Specialist $50 $50 $50

Referrals Required No No No

Inpatient Hospital $295 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 $6,700 In-network $6,700 In-network

Rx Deductible $195 tiers 4-5 $195 tiers 4-5 $415 tiers 3-5

Rx Preferred

$8/$15/$47/$99/29%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy

$8/$15/$47/$99/29%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy

$4/$8/$47/$100/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy

Key Extra Benefits Vision, Hearing, Fitness, OTC allowance $25/Quarter

Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter

Dental, Vision, Fitness, OTC allowance $25/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

No Coverage No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter

Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter

Market Service Area Barry, Lawrence, Newton Joplin Marketwide Statewide in Arkansas, Missouri

MISSOURI | JOPLIN MA/MAPD PLANS

Plan Name Humana Gold Choice (PFFS)

Plan Number H8145-120-000

Plan Highlights Networked MA only PFFS in select counties in AR/KS/MO and OK

Premium $43

PCP $20

Specialist $50

Referrals Required No

Inpatient Hospital $360 per day Days 1-5

Max Out-of-Pocket $6,700 In-network

Rx Deductible No Coverage

Rx Preferred No Coverage

Key Extra Benefits Vision

Market Service Area Joplin Marketwide

MISSOURI | JOPLIN MA/MAPD PLANS

MEDICARE ADVANTAGE PLANS

MARKET HIGHLIGHTS• New $0 HMO narrow network plan partnering

with St Lukes, Encompass and Partners in Primary Care

• $0 PCP copay on HMO plans, No referrals required on HMO plans

• Go365 on select plans. Members can earn up to $300 in gift cards and Go365 bucks can be spent in Go365 mall

• Those who qualify for LIS will get help on plan premiums when offered

• Many plans include Dental, Vision, Hearing, OTC allowance, 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

• Web MD technology on select plans

NETWORK HIGHLIGHTS• Broad HMO network in KC metro, includes

many of the provider systems

• New narrow network plan includes St. Lukes, PIPC, Encompass providers and Discover vision

MARKET SERVICE AREACass, Clay, Clinton, Jackson, Johnson, Lafayette, Platte, Ray

MISSOURI KANSAS CITY

NEW

Plan Name Humana Community (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO)

Plan Number H7621-001-000 H0028-017-000 H5216-033-001

Plan Highlights$0 plan premium HMO, $0 PCP,$30 Spec,$3400 MOOP, $0 Rx Ded, 2K dental/denture, vision, hearing, SilverSneakers, OTC allowance

broad network HMO $15 plan premium, $0 PCP copay, $0 Rx deductible all tiers dental, vision, hearing, OTC allowance and more

$35 plan premium LPPO MAPD, $0 Rx ded, SilverSneakers, vision, hearing, OTC allowance and more

Premium $0 $15 $35

PCP $0 $0 $15

Specialist $30 $45 $45

Referrals Required No No No

Inpatient Hospital $250 per day Days 1-7 $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 No Deductible 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/$99/33%; $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 from Humana Pharmacy

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $50/Quarter

Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter

Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter

Market Service Area Kansas: Johnson, Wyandotte; Missouri: Jackson

Kansas: Douglas, Jefferson, Johnson, Leavenworth, Miami, Shawnee, Wyandotte; Missouri: Cass, Clay, Jackson, Johnson, Lafayette, Platte, Ray

Kansas: Douglas, Jefferson, Johnson, Leavenworth, Miami, Shawnee, Wyandotte; Missouri: Cass, Clay, Jackson, Johnson, Lafayette, Platte, Ray

MISSOURI | KANSAS CITY MA/MAPD PLANS

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

Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter Vision

Market Service Area

Kansas: Douglas, Jefferson, Johnson, Leavenworth, Miami, Shawnee, Wyandotte; Missouri: Cass, Clay, Jackson, Johnson, Lafayette, Platte, Ray

Kansas: Douglas, Jefferson, Johnson, Leavenworth, Miami, Shawnee, Wyandotte; Missouri: Cass, Clay, Jackson, Johnson, Lafayette, Platte, Ray

Kansas: Johnson, Leavenworth, Wyandotte; Missouri: Cass, Clay, Jackson, Platte

MISSOURI | KANSAS CITY MA/MAPD PLANS

MEDICARE ADVANTAGE PLANS

MARKET HIGHLIGHTS• Introducing new PPO options

• $40 part B premium giveback LPPO MA only, good fit for veterans

• 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

• Go365 on select plans. Members can earn up to $300 in gift cards and Go365 bucks can be spent in Go365 mall

• Offer MA/PD and MA only plans LPPO; RPPO and PFFS

• Those who qualify for LIS will get premium relief on plans with premiums

NETWORK HIGHLIGHTS• LPPOs and RPPOs have a national network.

Receive in network benefits when visiting in network facilities outside of plan service area

MARKET SERVICE AREAAdair, Andrew, Atchison, Audrain, Barton, Bates, Benton, Bollinger, Boone, Buchanan, Butler, Caldwell, Callaway, Camden, Cape Girardeau, Carroll, Carter, Chariton, Clark, Cole, Cooper, Crawford, Daviess, Dekalb, Dent, Dunklin, Gasconade, Gentry, Grundy, Harrison, Henry, Holt, Howard, Iron, Knox, Lewis, Lincoln, Linn, Livingston, Macon, Madison, Maries, Marion, Mercer, Miller, Mississippi, Moniteau, Monroe, Montgomery, Morgan, New Madrid, Nodaway, Oregon, Osage, Pemiscot, Perry, Pettis, Phelps, Pike, Putnam, Ralls, Randolph, Reynolds, Ripley, Sainte Genevieve, Saline, Schuyler, Scotland, Scott, Shannon, Shelby, Stoddard, Sullivan, Texas, Vernon, Wayne, Worth

MISSOURI MISSOURI OUTSTATE

Plan Name HumanaChoice (PPO) HumanaChoice (PPO) HumanaChoice (Regional PPO)

Plan Number H5216-033-001 H5216-032-000 R1532-002-000

Plan Highlights$35 plan premium LPPO MAPD, $0 Rx ded, SilverSneakers, vision, hearing, OTC allowance and more. KS-MO Low option LPPO

KS-MO High Option LPPOStatewide RPPO MAPD Arkansas and Missouri. Not commissionable in LPPO service area

Premium $35 $83 $109

PCP $15 $20 $20

Specialist $45 $50 $50

Referrals Required No No No

Inpatient Hospital $295 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 $6,700 In-network $6,700 In-network

Rx Deductible No Deductible $195 tiers 4-5 $415 tiers 3-5

Rx Preferred

$8/$15/$47/$99/33%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy

$8/$15/$47/$99/29%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy

$4/$8/$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 $25/Quarter

Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter

Dental, Vision, Fitness, OTC allowance $25/Quarter

Market Service Area

Boone, Cole, Camden, Lincoln, Callaway, Phelps, Pettis, Benton, Henry, Morgan, Crawford, Audrain, Miller, Saline, Vernon, Bates, Wayne, Cooper, Bollinger, Moniteau, among others

Boone, St. Francois, Cole, Camden, Lincoln, Callaway, Phelps, Pettis, Benton, Henry, Morgan, Crawford, Audrain, Miller, Saline, Vernon, Bates, Wayne, Cooper, Bollinger, among others

Statewide in Arkansas, Missouri

MISSOURI | MISSOURI OUTSTATE MA/MAPD PLANS

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

No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter

Market Service AreaBenton, Boone, Callaway, Carroll, Cole, Crawford, Henry, Miller, Montgomery, Pemiscot, Perry, Phelps, Pike, Reynolds, Vernon

Cape Girardeau, Camden, Butler, Scott, Dunklin, Stoddard, Marion, Macon, Wayne, Mississippi, Bollinger, Grundy, Ralls, DeKalb, Lewis, Chariton, Carter, Clark, Sullivan, among others

Boone, St. Francois, Cole, Camden, Lincoln, Callaway, Phelps, Pettis, Benton, Henry, Morgan, Crawford, Audrain, Miller, Saline, Vernon, Bates, Wayne, Cooper, Bollinger, among others

MISSOURI | MISSOURI OUTSTATE MA/MAPD PLANS

Plan Name HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Humana Gold Choice (PFFS)

Plan Number R1532-001-000 H8145-120-000 H2944-197-000

Plan HighlightsRPPO MA only $0 plan premium with $30.50 Part B premium giveback. Not commissionable in LPPO service area

Networked MA only PFFS in select counties in AR/KS/MO and OK Partial network PFFS MA only

Premium $0 $43 $75

PCP $0 $20 $20

Specialist $35 $50 $50

Referrals Required No No No

Inpatient Hospital $295 per day Days 1-5 $360 per day Days 1-5 $360 per day Days 1-5

Max Out-of-Pocket $3,900 In-network $6,700 $6,700

Rx Deductible No Coverage No Coverage No Coverage

Rx Preferred No Coverage No Coverage No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Vision

Market Service Area Statewide in Arkansas, Missouri

Barton, Benton, Boone, Callaway, Carroll, Cole, Crawford, Gasconade, Henry, Miller, Montgomery, Pemiscot, Perry, Phelps, Pike, Reynolds, Sainte Genevieve, Vernon

Adair, Bollinger, Butler, Camden, Cape Girardeau, Dent, Dunklin, Grundy, Iron, Linn, Macon, Madison, Marion, Mississippi, New Madrid, Nodaway, Scott, Ripley, Stoddard, Wayne among others

MISSOURI | MISSOURI OUTSTATE MA/MAPD PLANS

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 premium relief on plans with premiums

• 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, Cox and Freeman are some of the in

network providers

• LPPOs and RPPOs have a national network. Receive in network benefits when visiting in network facilities outside of plan service area

MARKET SERVICE AREACedar, Christian, Dade, Dallas, Douglas, Greene, Hickory, Howell, Jasper, Laclede, Ozark, Polk, Pulaski, Saint Clair, Stone, Taney, Webster, Wright

MISSOURI SPRINGFIELD

Plan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H0028-016-000 H5216-033-001 H5216-032-000

Plan HighlightsLow premium plan, with dental, vision, hearing, OTC allowance and more

$35 plan premium LPPO MAPD, $0 Rx ded, SilverSneakers, vision, hearing, OTC allowance and more. KS-MO Low option LPPO

KS-MO High Option LPPO

Premium $18 $35 $83

PCP $0 $15 $20

Specialist $45 $45 $50

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 $5,900 In-network $6,700 In-network $6,700 In-network

Rx Deductible $195 tiers 4-5 No Deductible $195 tiers 4-5

Rx Preferred

$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

$8/$15/$47/$99/29%; $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

Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter

Market Service Area Springfield MarketwideCedar, Christian, Dade, Dallas, Douglas, Greene, Hickory, Howell, Laclede, Ozark, Polk, Pulaski, Saint Clair, Stone, Taney, Webster, Wright

Cedar, Christian, Dade, Dallas, Douglas, Greene, Hickory, Howell, Laclede, Ozark, Polk, Pulaski, Saint Clair, Stone, Taney, Webster, Wright

MISSOURI | SPRINGFIELD MA/MAPD PLANS

Plan Name HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) HumanaChoice (PPO)

Plan Number R1532-002-000 H8145-125-000 H5216-140-000

Plan HighlightsStatewide RPPO MAPD Arkansas and Missouri. Not commissionable in LPPO service area

Missouri 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 $109 $81 $0

PCP $20 $15 $0

Specialist $50 $45 $35

Referrals Required No No No

Inpatient Hospital $360 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 $415 tiers 3-5 $195 tiers 3-5 No Coverage

Rx Preferred

$4/$8/$47/$100/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy

$8/$15/$47/$99/29%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy

No Coverage

Key Extra Benefits Dental, Vision, Fitness, OTC allowance $25/Quarter Dental, Vision, Hearing, Fitness Dental, Vision, Hearing, Fitness,

OTC allowance $25/Quarter

Market Service Area Statewide in Arkansas, MissouriCedar, Christian, Dade, Dallas, Douglas, Greene, Hickory, Jasper, Laclede, Ozark, Polk, Pulaski, Saint Clair, Stone, Taney, Wright

Springfield Marketwide

MISSOURI | SPRINGFIELD MA/MAPD PLANS

NEW

Plan Name HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Humana Gold Plus (HMO)

Plan Number R1532-001-000 H8145-120-000 H4623-001-000

Plan HighlightsRPPO MA only $0 plan premium with $30.50 Part B premium giveback. Not commissionable in LPPO service area

Networked MA only PFFS in select counties in AR/KS/MO and OK

$0 HMO, $0 PCP, $3400 MOOP, No Rx ded, 2K dental/denture cov, vision, hearing, OTC allowance, SilverSneakers and more

Premium $0 $43 $0

PCP $0 $20 $0

Specialist $35 $50 $40

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 $3,900 In-network $6,700 In-network $3,400 In-network

Rx Deductible No Coverage No Coverage No Deductible

Rx Preferred No Coverage No Coverage

$6/$11/$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 Vision Dental, Vision, Hearing, Fitness,

OTC allowance $75/Quarter

Market Service Area Statewide in Arkansas, MissouriCedar, Christian, Dade, Dallas, Douglas, Greene, Hickory, Jasper, Laclede, Ozark, Polk, Pulaski, Saint Clair, Stone, Taney, Wright

Springfield Marketwide

MISSOURI | SPRINGFIELD MA/MAPD PLANS

MEDICARE ADVANTAGE PLANS

MARKET HIGHLIGHTS• $0 plan premium HMO, $0 PCP copay, $2900

MOOP and $0 Rx ded on HMO

• $0 LPPO MA/PD, $3600 MOOP now includes SilverSneakers

• No referrals required on HMO plans

• ED Rx covered on select plan HMO and LPPO plans

• Many plans include Dental, Vision, Hearing, OTC allowance, SilverSneakers and more

• MAPD plans offer preferred Rx cost shares with $0 copay for tiers 1 & 2 Humana pharmacy 90-day mail order

• Go365 on select plans. Members can earn up to $300 in gift cards and Go365 bucks can be spent in Go365 mall

• Web MD on select plans

NETWORK HIGHLIGHTS• HMO network, includes BJC, Mercy, SSM

and more

• LPPOs and RPPOs have a national network. Receive in network benefits when visiting in network facilities outside of plan service area

MARKET SERVICE AREAFranklin, Jefferson, Saint Charles, Saint Francois, Saint Louis, Saint Louis City, Warren, Washington

MISSOURI ST. LOUIS

Plan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H0028-014-000 H5216-033-002 H5216-032-000

Plan Highlights$0 plan premium HMO, $0 PCP, $35 Spec, $2900 MOOP, $0 Rx ded, $2000 dental/w denture, vision, hearing, OTC allowance & more

$0 plan premium LPPO MAPD, $3600 MOOP, $0 Rx ded, dental/with denture, vision, SilverSneakers, hearing aid, OTC allowance

KS-MO High Option LPPO

Premium $0 $0 $83

PCP $0 $10 $20

Specialist $35 $45 $50

Referrals Required No No No

Inpatient Hospital $295 per day Days 1-8 $245 per day Days 1-8 $360 per day Days 1-5

Max Out-of-Pocket $2,900 In-network $3,600 In-network $6,700 In-network

Rx Deductible No Deductible No Deductible $195 tiers 4-5

Rx Preferred

$6/$11/$47/$99/33%; $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

$8/$15/$47/$99/29%; $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

Dental, Vision, Hearing, Fitness, OTC allowance $50/Quarter

Dental, Vision, Hearing, Fitness, OTC allowance $25/Quarter

Market Service Area St. Louis MarketwideJefferson, Saint Charles, Saint Francois, Saint Louis, Saint Louis City, Warren, Washington

Jefferson, Saint Charles, Saint Francois, Saint Louis, Saint Louis City, Warren, Washington

MISSOURI | ST. LOUIS MA/MAPD PLANS

Plan Name HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) HumanaChoice (PPO)

Plan Number R1532-002-000 H8145-125-000 H5216-140-000

Plan HighlightsStatewide RPPO MAPD Arkansas and Missouri. Not commissionable in LPPO service area

Missouri 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 $109 $81 $0

PCP $20 $15 $0

Specialist $50 $45 $35

Referrals Required No No No

Inpatient Hospital $360 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 $415 tiers 3-5 $195 tiers 3-5 No Coverage

Rx Preferred

$4/$8/$47/$100/25%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy

$8/$15/$47/$99/29%; $0 copay for tiers 1 & 2 through mail order for a 90 day supply from Humana Pharmacy

No Coverage

Key Extra Benefits Dental, Vision, Fitness, OTC allowance $25/Quarter Dental, Vision, Hearing, Fitness Dental, Vision, Hearing, Fitness,

OTC allowance $25/Quarter

Market Service Area Statewide in Arkansas, Missouri Jefferson, Saint Charles, Saint Louis, Saint Louis City

Jefferson, Saint Charles, Saint Francois, Saint Louis, Saint Louis City, Warren, Washington

MISSOURI | ST. LOUIS MA/MAPD PLANS

Plan Name HumanaChoice (Regional PPO) Humana Gold Choice (PFFS)

Plan Number R1532-001-000 H8145-120-000

Plan HighlightsRPPO MA only $0 plan premium with $30.50 Part B premium giveback. Not commissionable in LPPO service area

Networked MA only PFFS in select counties in AR/KS/MO and OK

Premium $0 $43

PCP $0 $20

Specialist $35 $50

Referrals Required No No

Inpatient Hospital $295 per day Days 1-5 $360 per day Days 1-5

Max Out-of-Pocket $3,900 In-network $6,700 In-network

Rx Deductible No Coverage No Coverage

Rx Preferred No Coverage No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Vision

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

Dental $2500 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 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

Dental $2500 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 $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

Current Service Area

Adair, Audrain, Bates, Benton, Bollinger, Boone, Caldwell, Callaway, Carroll, Carter, Cole, Cooper, Daviess, Dekalb, Franklin, Gentry, Grundy, Henry, Hickory, Howard, Lincoln, Livingston, Macon, Miller, Mississippi, Moniteau, Monroe, Montgomery, Morgan, Oregon, Osage, Ozark, Pettis, Phelps, Ray, Reynolds, Saint Clair, Sainte Genevieve, Saline, Schuyler, Scotland, Scott, Shelby, Stoddard, Sullivan, Texas, Vernon, Wayne

Plan Name Humana Preferred Rx Plan (PDP) Humana Walmart Rx Plan (PDP)

Plan Number S5884-140-000 S5884-164-000

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 $29.00 $29.20

Rx Deductible $415 all tiers $415 tiers 3-5

Preferred Retail 30-day Supply No Coverage $1/$4/21%/35%/25%

Standard Retail 30-day Supply $0/$1/25%/38%/25% $10/$20/25%/50%/25%

Preferred Mail 90-day Supply $0 copay for tiers 1 & 2 $0 copay for tier 1, $8 copay for

tier 2

Market Service Area Missouri Statewide Missouri Statewide

MISSOURI PDP PLANS

LOCAL SUPPORT

MISSOURI

Bob NabazasBroker Relationship Manager (913) 461-4087 rnabazas@humana.com

Brandon RasmussenBroker Relationship Executive(855) 305-4947 brasmussen@humana.com

Local Market Office(913) 217-3300