TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the HumanaChoice SNP-DE H5216-205 (PPO D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify for both ...Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the HumanaChoice H5216-179 (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $30.20 (see Plan Premium Details below) Annual ...TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the HumanaChoice H5216-207 (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 (see Plan Premium Details below) Annual Deductible: $75 (Tier 1 and 2 excluded from the Deductible.) Annual Initial Coverage Limit (ICL):4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-157 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-157-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.HumanaChoice H5216-309 (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included. ... 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.The HumanaChoice H5216-248 (PPO) (H5216 - 248) currently has 17,725 members. There are 410 members enrolled in this plan in Orange, Virginia, and 17,635 members in Virginia. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars.4.5 out of 5 stars* for plan year 2023. HumanaChoice H5216-021 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-021-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $44.00 Monthly Premium.HumanaChoice H5216-266 (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included. ... 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.H5216 - 280 - 2. (4.5 / 5) HumanaChoice H5216-280 (PPO) is a Medicare Advantage (Part C) Plan by Humana. Premium: $45.70. Enroll Now. This page features plan details for 2024 HumanaChoice H5216-280 (PPO) H5216 - 280 - 2 available in South Carolina. IMPORTANT: This page has been updated with plan and premium data for 2024.TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the HumanaChoice H5216-207 (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 (see Plan Premium Details below) Annual Deductible: $75 (Tier 1 and 2 excluded from the Deductible.) Annual Initial Coverage Limit (ICL):HumanaChoice H5216-080 (PPO) is a Medicare Advantage (Part C) Plan by Humana. Premium: $49.5. Enroll Now. This page features plan details for 2022 HumanaChoice H5216-080 (PPO) H5216 - 080 - 2 available in Twin Cities, Rochester, Duluth Areas. IMPORTANT: This page features the 2022 version of this plan. See the 2024 version using the link below:4.5 out of 5 stars* for plan year 2024. Humana Value Plus H5216-160 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-160-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $40.10 Monthly Premium.HumanaChoice SNP-DE H5216-385 (PPO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B). Coverage. Cost. Chiropractic Services. In-Network: Copayment for Medicare-covered Chiropractic Services $0.00. Copayment for Routine Care $0.00.HumanaChoice H5216-266 (PPO) Location: Hanover, Virginia Click to see other locations: Plan ID: H5216 - 266 - 0 Click to see other plans: Member Services: ... (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance: Email a copy of the HumanaChoice H5216-266 (PPO) benefit ...Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $35.00. Out-of-Network: Doctor Specialty Visit: Coinsurance for Medicare Covered Physician Specialist Office Visit 40%. Inpatient Hospital Care. In-Network: Acute Hospital Services: $295.00 per day for days 1 to 5.HumanaChoice Florida H5216-311 (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included. ... 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your ...Humana USAA Honor (PPO) 4.5 out of 5 stars* for plan year 2024. Humana USAA Honor (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-301-004. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.HumanaChoice SNP-DE H5216-205 (PPO D-SNP) has a network of doctors, hospitals, pharmacies and other providers. You have access to Care Managers. Care Managers are nurses or care coordinators who support your health and well-being by providing additional services including acute and chronic-care management, telephonic and in-person health ...HumanaChoice H5216-317 (PPO) is a Medicare Advantage (Part C) Plan by Humana. This page features plan details for 2024 HumanaChoice H5216-317 (PPO) H5216 – 317 – 0 available in Kentucky and Southern Indiana. IMPORTANT: This page has been updated with plan and premium data for 2024.The HumanaChoice Florida H5216-062 (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $150 (excludes Tiers 1, 2 and 3) per year. Coverage. Cost. 30 day supply 60 day supply 90 day supply. Coverage & Cost. 30 day supply 60 day supply 90 day supply.4.5 out of 5 stars* for plan year 2024. HumanaChoice SNP-DE H5216-267 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-267-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.The HumanaChoice H5216-284 (PPO) has a monthly premium of $32.40. That is $388.80 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher.H5216 - 316 - 3. (4.5 / 5) HumanaChoice H5216-316 (PPO) is a Medicare Advantage (Part C) Plan by Humana. Premium: $26.00. Enroll Now. This page features plan details for 2024 HumanaChoice H5216-316 (PPO) H5216 – 316 – 3 available in Select Counties in Oklahoma. IMPORTANT: This page has been updated with plan and premium data for 2024.Prescription Drug Costs and Coverage. The HumanaChoice H5216-358 (PPO) offers prescription drug coverage, with an annual drug deductible of $395.00 (excludes Tiers 1 and 2) When reviewing Texas Medicare plans, be sure to find out if your doctors are part of the plan network.4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-316 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-316-001. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $28.00 Monthly Premium.4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-186 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-186-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $39.00 Monthly Premium.In addition, you may pay a higher co-pay for services received by non-contracted providers. Summary of Benefits. HumanaChoice H5216-251 (PPO) Chicago/Rockford Select Counties in Illinois. 2023. Our service area includes the following county/counties in Illinois: Boone, Cook, DeKalb, DuPage, Grundy, Kane, Kankakee, Kendall, Lake, McHenry, Ogle ...4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-017 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-017-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-017 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-017-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-247 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-247-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.HumanaChoice H5216-247 (PPO) HumanaChoice H5216-247 (PPO) is a Medicare Advantage (Part C) Plan by Humana. This page features plan details for 2024 HumanaChoice H5216-247 (PPO) H5216 - 247 - 0 available in Select counties in OR,UT,WA. IMPORTANT: This page has been updated with plan and premium data for 2024.To join HumanaChoice H5216-043 (PPO), you must be entitled to Medicare Part A, be enrolled in Medicare Part B and live in our service area. Plan name: HumanaChoice H5216-043 (PPO) How to reach us: If you're amember of this plan, call toll-free: 1-800-457-4708 (TTY: 711) . If you're not amember of this plan, call toll free: 1-800-833-2364 (TTY:Cost Summary. HumanaChoice H5216-279 (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $750 annual deductible and a maximum out of pocket cost sharing of $3,450 In and Out-of-network $3,450 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit ...HumanaChoice H5216-319 (PPO) 4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-319 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-319-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.HumanaChoice H5216-214 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-214-001 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.Create Account. View the coverage and benefits provided in the HumanaChoice Florida H5216-304 (PPO) plan from Humana. Alight Retiree Health Solutions represents Medicare plans from 61 insurers nationwide.Cost Summary. HumanaChoice Florida H5216-304 (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,900 In and Out-of-network $4,700 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist ...Point-of-service, health maintenance organization, and preferred provider organization are the three common group health insurance structures in the United States. POS insurance bl...HumanaChoice SNP-DE H5216-220 (PPO D-SNP) West Virginia. Medicare. Health. HumanaChoice SNP-DE (PPO D-SNP) H5216-220. Humana ... Local PPO. Monthly Plan Premium. $0.00. Health Plan Deductible. $0.00.4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-106 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-106-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $22.00 Monthly Premium.HumanaChoice SNP-DE H5216-290 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-290-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.To join HumanaChoice H5216-300 (PPO), you must be entitled to Medicare Part A, be enrolled in Medicare Part B and live in our service area. Plan name: HumanaChoice H5216-300 (PPO) How to reach us: If you're amember of this plan, call toll-free: 1-800-457-4708 (TTY: 711) . If you're not amember of this plan, call toll free: 1-800-833-2364 (TTY:Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $35.00. Out-of-Network: Doctor Specialty Visit: Copayment for Medicare Covered Physician Specialist Office Visit $65.00. Inpatient Hospital Care. In-Network: Acute Hospital Services: $285.00 per day for days 1 to 6.HumanaChoice H5216-284 (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B). Coverage. Cost. Chiropractic Services. In-Network: Copayment for Medicare-covered Chiropractic Services $15.00. Copayment for Routine Care $10.00.4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-312 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-312-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.This Medicare Advantage Plan with Prescription Drug Coverage is a Local PPO plan. Plan Membership and Plan Ratings: The HumanaChoice H5216-306 (PPO) (H5216 - 306) …4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-308 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-308-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.Out-of-Network: Copayment for Medicare Covered Podiatry Services $40.00 Copayment for Non-Medicare Covered Podiatry Services $10.00. Skilled Nursing Facility Care. In-Network: Skilled Nursing Facility Services: $10.00 per day for days 1 to 20. $203.00 per day for days 21 to 100.HumanaChoice H5216-283 (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B). Coverage. Cost. Chiropractic Services. In-Network: Copayment for Medicare-covered Chiropractic Services $20.00. Copayment for Routine Care $20.00.Your plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. $350 copay per day for days 1-5 $0 copay per day for days 6-90. 50% of the cost. Outpatient group and individual therapy visits. Cost share may vary depending on where service is provided.This Medicare Advantage Plan with Prescription Drug Coverage is a Local PPO plan. Plan Membership and Plan Ratings: The HumanaChoice H5216-224 (PPO) (H5216 - 224) currently has 5,249 members. There are 2,440 members enrolled in this plan in Maricopa, Arizona. ... (Preferred Generic) contains 306 drugs and has a co-payment of $0.00. Tier 2 ...HumanaChoice H5216-080 (PPO) is a Medicare Advantage (Part C) Plan by Humana. Premium: $49.5. Enroll Now. This page features plan details for 2022 HumanaChoice H5216-080 (PPO) H5216 - 080 - 2 available in Twin Cities, Rochester, Duluth Areas. IMPORTANT: This page features the 2022 version of this plan. See the 2024 version using the link below:HumanaChoice Florida H5216-304 (PPO) H5216-304 Plan Details 4.5 out of 5 stars HumanaChoice Florida H5216-304 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.View the coverage and benefits provided in the HumanaChoice H5216-300 (PPO) plan from Humana. Alight Retiree Health Solutions represents Medicare plans from 61 insurers nationwide.4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-223 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-223-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $34.00 Monthly Premium.HumanaChoice SNP-DE H5216-228 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-228-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. Oklahoma Medicare beneficiaries may want to consider reviewing their Medicare ...HumanaChoice H5216-132 (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included. ... 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.HumanaChoice H5216-266 (PPO) Location: Hanover, Virginia Click to see other locations: Plan ID: H5216 - 266 - 0 Click to see other plans: Member Services: 1-800-457-4708 TTY users 711: Medicare Contact Information: Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048To join HumanaChoice H5216-263 (PPO), you must be entitled to Medicare Part A, be enrolled in Medicare Part B and live in our service area. Plan name: HumanaChoice H5216-263 (PPO) How to reach us: If you're amember of this plan, call toll-free: 1-800-457-4708 (TTY: 711) . If you're not amember of this plan, call toll free: 1-800-833-2364 (TTY:HumanaChoice H5216-309 (PPO) is a Medicare Advantage (Part C) Plan by Humana. Premium: $0.00 Enroll Now This page features plan details for 2024 HumanaChoice H5216-309 (PPO) H5216 – 309 – 0 available in Indiana, Ohio, & N KY.To join HumanaChoice H5216-043 (PPO), you must be entitled to Medicare Part A, be enrolled in Medicare Part B and live in our service area. Plan name: HumanaChoice H5216-043 (PPO) How to reach us: If you're amember of this plan, call toll-free: 1-800-457-4708 (TTY: 711) . If you're not amember of this plan, call toll free: 1-800-833-2364 (TTY:TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the HumanaChoice SNP-DE H5216-277 (PPO D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify for both ...Cost Summary. HumanaChoice H5216-306 (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $550 annual deductible and a maximum out of pocket cost sharing of $12,450 In and Out-of-network $7,550 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit ...TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the HumanaChoice H5216-300 (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 (see Plan Premium Details below) Annual Deductible: $200 (Tier 1, 2 and 3 excluded from the Deductible.) Annual Initial Coverage Limit (ICL):TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the HumanaChoice Florida H5216-068 (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 (see Plan Premium Details below) Annual Deductible: $150 (Tier 1, 2 and 3 excluded from the Deductible.) Annual Initial Coverage Limit (ICL):To join HumanaChoice H5216-138 (PPO), you must be entitled to Medicare Part A, be enrolled in Medicare Part B and live in our service area. Plan name: HumanaChoice H5216-138 (PPO) How to reach us: If you're amember of this plan, call toll-free: 1-800-457-4708 (TTY: 711) . If you're not amember of this plan, call toll free: 1-800-833-2364 (TTY:The HumanaChoice H5216-306 (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $545 (excludes Tiers 1 and 2) per year. Coverage. Cost. 30 day supply 60 day supply 90 day supply. Coverage & Cost. 30 day supply 60 day supply 90 day supply. Annual Drug Deductible:HumanaChoice H5216-284 (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B). Coverage. Cost. Chiropractic Services. In-Network: Copayment for Medicare-covered Chiropractic Services $15.00. Copayment for Routine Care $10.00.H5216 - 160 - 0. (4.5 / 5) Humana Value Plus H5216-160 (PPO) is a Medicare Advantage (Part C) Plan by Humana. Premium: $40.10. Enroll Now. This page features plan details for 2024 Humana Value Plus H5216-160 (PPO) H5216 - 160 - 0 available in Select Counties in Mississippi. IMPORTANT: This page has been updated with plan and premium data ...4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-253 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-253-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.Mental health services. Inpatient hospital - psychiatric. In-Network: $0 or $587 per day for days 1 through 3 / $0 per day for days 4 through 90. Out-of-Network: $587 per day for days 1 through 3 ...HumanaChoice H5216-247 (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B). Coverage. Cost. Chiropractic Services. In-Network: Copayment for Medicare-covered Chiropractic Services $15.00. Copayment for Routine Care $20.00.4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-347 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-347-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-347 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-347-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $35.00. Out-of-Network: Doctor Specialty Visit: Copayment for Medicare Covered Physician Specialist Office Visit $65.00. Inpatient Hospital Care. In-Network: Acute Hospital Services: $280.00 per day for days 1 to 7.4.5 out of 5 stars* for plan year 2024. HumanaChoice SNP-DE H5216-331 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-331-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.To join HumanaChoice H5216-275 (PPO), you must be entitled to Medicare Part A, be enrolled in Medicare Part B and live in our service area. Plan name: HumanaChoice H5216-275 (PPO) How to reach us: If you're amember of this plan, call toll-free: 1-800-457-4708 (TTY: 711) . If you're not amember of this plan, call toll free: 1-800-833-2364 (TTY:Local PPO. Monthly Plan Premium. $0.00. Health Plan Deductible. $0.00. Prescription Drug Plan Deductible. $200.00. Out-of-Pocket Spending Limit. $5,300.00. Monthly Drug Premium *Included in ...Mental health services. Inpatient hospital - psychiatric. In-Network: $0 or $587 per day for days 1 through 3 / $0 per day for days 4 through 90. Out-of-Network: $587 per day for days 1 through 3 ...