The Humana Gold Choice Medicare Advantage plan is a private fee-for-service (PFFS) plan. That means, strictly speaking there isn’t a provider network with this kind of plan. However, since there is no network, your provider chooses at the point of service whether to accept this Medicare PFFS plan or not. A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. The network providers (that is, providers who have signed contracts with Humana) have already agreed to see members of our plan. If your provider is not one of Humana’s network providers, then the provider is not required to agree to accept the plan’s terms and conditions, of payment, they may choose not to provide health care services to you, except in emergencies. If this happens, you will need to find another provider that will accept our terms and conditions of payment. Humana has also included Part D prescription drug coverage into this plan.
Outpatient Mental Health Care
- $30 copayment for each Medicare-covered individual therapy visit
- $30 copayment for each Medicare-covered group therapy visit
- $30 copayment for each Medicare-covered therapy visit with a psychiatrist
- 20% of the cost for Medicare-covered partial hospitalization program services
- 20% of the cost for each Medicare-covered ambulatory surgical center visit
- 20% to 25% of the cost for each Medicare-covered outpatient hospital facility visit
- $150 copayment for Medicare-covered ambulance benefits.
- $65 copayment for Medicare-covered emergency room visits
- $25,000 plan coverage limit for emergency services outside the U.S. every year.
Outpatient Rehabilitation Services
- There may be limits on physical therapy, occupational therapy, and speech and language pathology services If so, there may be exceptions to these limits.
- $30 copayment [or 25% of the cost] for Medicare-covered Occupational Therapy visits
- $30 copayment [or 25% of the cost] for Medicare-covered Physical and/or Speech and Language Therapy visits
Durable Medical Equipment
- 20% of the cost for Medicare-covered items
Diabetes Programs and Supplies
- $0 copayment for Diabetes self-management training
- 0% to 20% of the cost for Diabetes monitoring supplies
- $10 copayment for Therapeutic shoes or inserts
Inpatient Hospital Care
- You may go to any doctor, specialist, or hospital that accepts the plan’s terms and conditions of payment except in emergencies.
- No limit to the number of days covered by the plan each hospital stay.
- For Medicare-covered hospital stays:
- Days 1 – 7: $225 copayment per day.
- Days 8 – 90: $0 copayment per day.
- $0 copayment for each additional hospital day.
Skilled Nursing Facility (SNF)
- Plan covers up to 100 days each benefit period
- No prior hospital stay is required.
- For SNF stays:
- Days 1 – 7: $0 copayment per day
- Days 8 – 100: $50 copayment per day
Home Health Care
- $0 copayment for Medicare-covered home health visits
- $20 copayment for each Medicare-covered visit
- Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers.
Humana Gold Choice Frequently Asked Questions
What is the medical maximum out of pocket?
It is $6700 for medical expenses only, not including Part D prescription drug benefits.
When Can I enroll?
Of course when you first become eligible for Medicare Part A and B, you have you’re “Open Enrollment Period” in which you can enroll. Outside of that time frame, you can enroll during the “Annual Enrollment Period” which runs every year from Oct to Dec, with a Jan effective date.