Gold Choice Medicare Advantage PFFS Plan from Humana

Gold Choice Medicare Advantage PFFS Plan from Humana

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.


Plan Benefits


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

Outpatient Services/Surgery

  • 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

Ambulance Services

  • $150 copayment for Medicare-covered ambulance benefits.

Emergency Care

  • $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

Chiropractic Services

  • $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 my premium?
The premium in Florida averages $99 a month. Your can compare medicare plans and prices by getting a medicare supplement insurance quote here.

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.

12 Comments

  1. I HAVE HUMANA GOLD CHOICE (pffs) I HAVE HAD THIS PLAN SINCE DECEMBER 2008. MY PRIMARY CARE DOCTOR WITH CHESAPEAKE INTERNIST LTD. CHESAPEAKE,VA.23320,HAS BEEN ACEPTING THIS PLAN AND NOW MY PLAN WON’T PAY.SO WHAT IS THE PROBLEM? MY PRIMARY CARE DOCTOR (DR.BRIAN ODDONELL) IS THE ONE THAT KEEPS ME TRACK FOR MY HEALTH. CHANGING MY DOCTOR IS SOMETHING THAT I DON’T WANT TO DO,BUT IF I MUST,COULD YOU GIVE ME A LIST OF PRIMARY CARE DOCTORS IN CHESAPEAKE,VA.23320 THAT WILL ACCEPT THIS PLAN. THANK YOU.

    Reply
  2. Does my plan cover smoking cessation program

    Reply
    • Yes, Under this plan it is covered under Preventive Care.

      Reply
  3. does humana gold choice in georgia cover hearing aids???

    Reply
  4. Is this plan available in the Texas panhandle?

    Reply
  5. I am moving to Mesa AZ 85209 and need a list of physicians in your contracted provider network. Thank you.

    Reply
  6. I have Humana Gold Choice H8145-123 (PFFS) and Medicaid in Colorado. I do qualify for Medicare as I am disabled. The State of Colorado is paying (as I am told) $121.80 for the premium (to whom I’m not sure) and my premium with Humana is $71.30 of which I pay. Why do I need this policy?

    Reply
  7. Is Baylor Scott & White in Washington Co Texas and Brazos Co Texas in Humana Gold Choice PFFS network

    Reply
  8. I am looking for a dr. in my area who will accept Humana Gold Choice (PFFS)

    Reply
  9. With this plan and I am disabled which plan pays first??

    Reply

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