Take a look at the Humana Gold Plus HMO plan for Seniors

Take a look at the Humana Gold Plus HMO plan for Seniors

Humana Gold Plus® is a Medicare Advantage Health Maintenance Organization (HMO) plan with a wide range of coverage for seniors. Humana has contracted with Medicare to provide you with services that are not covered by your Medicare Part A and Part B benefits under original Medicare. Most Medicare Advantage Humana Gold Plus HMO Plans offer prescription drug coverage. With Gold Plus HMO Plans your out-of-pocket costs are reduced and more predictable than with the majority of other plans. You may enroll in Gold Plus HMO plan only during specific times of the year. You can compare this to Humana’s Gold Choice PFFs, Humana’s Part D Drug Plans, HumanaChoice PPO and Humana Enhanced PDP. Below is an example of one of the many plans offered by Humana.

Summary


Plan Type Humana Gold Plus H1951-013 (HMO)
Office Visit for Primary Doctor $10 copay for each primary care doctor visit for Medicare-covered benefits.
Office Visit for Specialist $10 to $25 copay for each specialist visit for Medicare-covered benefits.
Doctor Choice Plan Doctor Only
Annual Deductible None
Out-of-Pocket Maximum $4,900
Prescription Drug Coverage Yes
Physical Exams $0 copay for all preventive services covered under Original Medicare at zero cost sharing.

Hospital Services Coverage


Emergency Room $65 copay for Medicare-covered emergency room visits. $25,000 plan coverage limit for emergency services outside the U.S. every year.
Ambulance Services $200 copay for Florida Medicare-covered ambulance benefits.
Outpatient Lab/X-Ray $0 to $25 copay for Medicare-covered lab services. $0 to $50 copay for Medicare-covered diagnostic procedures and tests. $10 to $50 copay for Medicare-covered X-rays.
Outpatient Surgery $250 copay for each Medicare-covered ambulatory surgical center visit. $0 to $250 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit.
Urgent Care $10 to $25 copay for Medicare-covered urgently needed care visits.
Hospitalization No limit to the number of days covered by the plan each hospital stay. For Medicare-covered hospital stays: Days 1 – 7: $175 copay per day; Days 8 – 90: $0 copay per day; $0 copay for each additional hospital day.
Outpatient Rehabilitation Services $10 copay for Medicare-covered Occupational Therapy visits. $10 copay for Medicare-covered Physical and/or Speech and Language Therapy visits.
Skilled Nursing Facility Plan covers up to 100 days each benefit period; No prior hospital stay is required. For SNF stays: Days 1 – 5: $0 copay per day; Days 6 – 20: $50 copay per day; Days 21 – 100: $100 copay per day.
Home Health Care $0 copay for each Medicare-covered home health visit.
Hospice You must get care from a Medicare-certified hospice.

Retail Pharmacy for Prescription Drugs

Prescription Drug Deductible None
Preferred Generic You pay the following until total yearly drug costs reach $2,930: – $6 copay for a one-month (30-day) supply of drugs in this tier; – $18 copay for a three-month (90-day) supply of drugs in this tier.
Non-Preferred Generic You pay the following until total yearly drug costs reach $2,930: – $10 copay for a one-month (30-day) supply of drugs in this tier; – $30 copay for a three-month (90-day) supply of drugs in this tier.
Preferred Brand You pay the following until total yearly drug costs reach $2,930: – $45 copay for a one-month (30-day) supply of drugs in this tier; – $135 copay for a three-month (90-day) supply of drugs in this tier.
Non-Preferred Brand You pay the following until total yearly drug costs reach $2,930: – $95 copay for a one-month (30-day) supply of drugs in this tier; – $285 copay for a three-month (90-day) supply of drugs in this tier.
Specialty 33% coinsurance for a one-month (30-day) supply of drugs in this tier.

Mail Order Pharmacy for Prescription Drugs


Preferred Generic You pay the following until total yearly drug costs reach $2,930: – $0 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy; – $0 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.
Non-Preferred Generic You pay the following until total yearly drug costs reach $2,930: – $0 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy; – $0 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.
Preferred Brand You pay the following until total yearly drug costs reach $2,930: – $45 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy; – $125 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.
Non-Preferred Brand You pay the following until total yearly drug costs reach $2,930: – $95 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy; – $275 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.
Specialty 33% coinsurance for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.

Additional Coverage


Dental Services $0 copay for the following preventive dental benefits: – $0 copay for up to 1 oral exam(s) every year; – $0 copay for up to 1 cleaning(s) every year; – $0 copay for up to 1 dental x-ray(s) every year. $25 copay for Medicare-covered dental benefits.
Hearing Services In general, routine hearing exams and hearing aids not covered. – $25 copay for Medicare-covered diagnostic hearing exams.
Vision Services $0 copay for one pair of eyeglasses or contact lenses after cataract surgery. – $0 to $25 copay for exams to diagnose and treat diseases and conditions of the eye. – $0 copay for up to 1 supplemental routine eye exam(s) every year.
Chiropractic Coverage $20 copay 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.
Outpatient Mental Health Coverage $25 copay for each Medicare-covered individual therapy visit, $25 copay for each Medicare-covered group therapy visit, $25 copay for each Medicare-covered individual therapy visit with a psychiatrist, $25 copay for each Medicare-covered group therapy visit with a psychiatrist, $25 copay for the cost for Medicare-covered partial hospitalization program services.

101 Comments

  1. I can’t tell from what you wrote about glasses and lenses whether you cover a pair of glasses with lenses for those who haven’t had cataract surgery. Could you please tell me

    Reply
    • $0 copay for one pair of eyeglasses or contact lenses after cataract surgery.

      Reply
      • What if I don’t have cataracts or the surgery! What’s the cost for glasses or contact lens?,

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      • I cannot find even 1 optometrist on the list Humana provided that honors this 1 pair of glasses after cataract surgery.My husband needs his glasses.. Please help with this I have been trying to remedy this for weeks now

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        • Try Walmart for his glasses

          Reply
        • I am an optician for nearly 20 years and this is one of the most confusing insurance coverages for both drs. and patients. Covered glasses means covered up to the allowed amount by Medicare, or Humana, or whatever ins. you have. Those allowed amounts are determined by Medicare and cover 80% of a frame up to $50.00 and a lined bifocal or lined trifocal in standard plastic approximately $45-$48 for lenses. Most optical shops have you pay out of pocket and then the small reimbursement check,usually totally around $145.00, will be sent to you. Any no-line or more expensive frame you will be charged the overage out of pocket. I hope this has helped answer some of your questions.

          Reply
          • I am having a hard time understanding and finding the right optician here in Largo, FL.

      • Is cataract surgery covered? Enrolled in Humana Gold Medicare advantage; is there a co-pay or deductible?

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        • What is the co-pay for cataract surgery at a Ambulatory Surgery Center/

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    • is.a.pair.of.glasses.covered.without.surgury

      Reply
      • I just went thru this for my wife and myself.
        They will pay up to 200 dollars toward glasses and frames.
        Anything over 200 dollars You pay.

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        • Thanks for sharing.

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        • I was just told today by my eye doctor, they pay for exam, first $100 towards glasses then 20% of what’s left.

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    • Is this insurance, Humana Gold HMO available in PA?

      Reply
  2. Need to see if a tens unit for the lumbar would be cover through my plan, humans gold.

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  3. I receive help in paying my medications. How much will my medications cost on this plan? thank you

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  4. I just switched over to Humana On January 1st. When I arrived at the office of a specialist whom I had already been seeing I was told that I needed a written referral from my primary care physician. Otherwise I would have to pay full price for the specialist visit. I have read all 4 of my booklets and all of my brochures but cannot find any place that says this is a requirement before seeing a specialist. Why wasn’t I informed of this policy? Was the specialist out of network? Thank you.

    Reply
    • This is standard with HMO’s. You are required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). If you need special care your PCP will make the arrangements (written referral) and tell you where you can go in the network.

      Reply
  5. Yeah for Humana’s Community HMO medicare supplement Plan.
    Satisfactory healthcare that was needed is getting attended to thanks. Only just recently found primary-care Physician that reviewed my on-going remedies for the conditions that me, myself has been treated using another HMO that was used the preceeding year. You know, doctor’s office visits can be stressful. This time was better & have been able to go make an appointment & go over each medication with a follow-up requested in 3 months by the Pysician.

    Going to the Dentist is for me, myself religiously accomplished on a regular basis. Until now was able to be seen, treated for any maladies & sent on my way through my Spouse’s insurance from work. Unfortunately however, due to personal reasons am no longer covered in that way presently. Disappointed also to find out that the Dentist that was my acquaintance isn’t accepting me as a paying customer using my current Humana Community HMO plan though am me, myself personally funding it. Just now am wondering if the customer service center will be able to help me in locating in the quickest way possible someone inside the system in the same wonderful means that they did my healthcare physician before?

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  6. Do you have a list of Dentists that accept Humama?

    Thank you.

    Reply
    • Sorry, you need to contact Humana. Hopefully we can provide a list in the future.

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      • Will Hummana Gold help pay for a nebula er for breathing

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  7. looking at Medicare supplement plans and wondering what to do. It would be almost $200 per month for a “g” plan but if I don’t do this, a hospitalization or illness scares me due the copays I would have with Humana Gold Plus HMO plan I now have. Do you have a better plan than the current one for me rather than losing me to another company? I just feel a little uncovered with the gold plus hmo due the potential copays if something happens to me. A Medicare supplement seems more prudent, somehow. Any suggestions? MD

    Reply
  8. Looking for info regarding Humana Gold Medical Plans. I am 61 years old have Medicare and Medicaid. Need doctor care for chronic conditions. Advanced osteoporosis Hep C stage 4 cirrohsis fibromyalgia kidney pain. Vancouver, WA 98661

    Reply
  9. My mom has the Human Gold Plus plan. Does the plan cover transportation from our home to her senior day care facility. She has dementia and goes to the facility Mon-Fri.
    Thank you.
    Gloria Mick

    Reply
    • Yes.

      Reply
  10. Need info on broken bottom plate.Will insurance help pay to fix it?

    Reply
    • Get assistance
      HumanaDental
      1-800-232-2006
      8 a.m. – 6 p.m., Monday – Friday

      Reply
  11. I have a prescription for my husbands glasses after cataract surgery.Unfortunatly all the names Humana provided do not honor the 0 copay under the regular medicare as stated in the book Humana provided They only except the Eye Med Discount.. How do I find someone to honor what is written in our book of services?

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  12. What hospitals are covered under Humana Gold Plus Plans…I live in zip code 34688

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  13. today I bought a extra coverage from my humana agent. at top of page it says guarantee trust life insurance company…and it is for hospital confinement benefit 300.00 per day. $62.65 is suppose to come out of my checking account each month. do I need this extra? or will medicare and my humana gold plus be enough for a hospital stay?

    Reply
    • Humana’s inpatient hospital Care coverage: (Your plan may vary)

      Days 1 – 7: $175 copay per day; Days 8 – 90: $0 copay per day; $0 copay for each additional hospital day.

      Reply
  14. I am planning to write about the service I have received for the last two years from Apria which is over 50 miles from my house. I want to change to my previous service which is one Block from me. How do I do this and who do I have to write> I am presently covered with Humana Gold Plus (HMO)

    Reply
    • To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. You’ll be disenrolled automatically from your old plan when your new plan’s coverage begins.

      Reply
  15. I have Humana insurance and was told by a rep. that I had a monthly benefit for over-the-counter drugs ordered from Humana pharmacy. How do I find out if this is true and how much is the benefit?

    Reply
    • Please contact Humana

      Reply
    • I have the Humana plan that offers the over the counter benefit thru their mail order pharmacy. For 2015, we are allowed $30.00 per month, shipping is free. If we order more than $30.00, we the policy holder, is responsible for the difference. They provide a booklet of items available or you can order online. Hope this helps.

      Reply
      • Thank you for Sharing!

        Reply
  16. I received a list of HCA hospitals that accept Humana Gold Plus.
    I live in Miami. Is Mt. Sinai Hospital covered by my plan

    Reply
  17. wanting to know more about the sneaker program, how to get in to a complete program

    Reply
  18. I lost my Humana Gold Plus reference book that lists the doctors, etc. in my area that I can use.
    Please tell me how to get a new one mailed to me because I have tried for hours to find a phone # on line and all I get is recordings that have nothing to do with what I need. PLEASE help me. Susan Surla

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  19. What is the co-pay for therapy on Humana Gold Plus (HMO)? And what is the co-pay on pain injections?

    Reply
    • The standard co-pay.

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  20. Will Humana HMO Gold Plus pay for NEW Dentures?
    Thank you!

    Reply
    • This plan offers limited dental services. Check with Humana to see.

      Reply
  21. Both I and my ex-husband have Humana Gold Plus. I moved him into my house to care for him. He is Bi-polar, has frontal lobe dementia and early stage Alzheimers. Can I get paid for “Home Healthcare” under our Humana Plan since he requires a Caregiver?

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  22. My father needs cataract surgery and I am trying to find out what Humana gold covers for that. Medicare has told me that it covers a standard 80%

    Reply
    • Yes

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  23. Is this Humana Gold Plus for Seniors availble in Lauderdale County Alabama?

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  24. Looking for additional dental benefits (supplement) to add to my Humana Gold HMO plan

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  25. I am trying to help my neighbor find an appropriate inpatient memory care center for his wife who has rapidly deteriorating Alzheimer’s disease. She has become too ill (mentally and physically) for him to continue caring for her at home but doesn’t know where to start. Will his Humana Gold Plus HMO pay for an inpatient facility for her?

    Reply
    • You may want to consider a SNP (Special Needs Plans) with institutionalized individuals (individuals residing or expecting to reside for 90 days or longer in a long-term care facility).

      Reply
  26. Is there any coverage for dentures.

    Reply
    • This plan offers limited dental services. Check with Humana to see.

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  27. My doctor may want me to have a special MRI that is not available in my network. Will I be charged out of network prices?

    Reply
    • Please Check with Humana

      Reply
  28. I am on Humana Gold Plus HMO Wellmed Pflugerville, Tx. I need to know if I can make an appointment to go to Spicewood Phychotherapy Group?
    Specialist for $45.00 and if I need to have a referral from my primary doctor. Where I can find a list of doctors that take this plan? Please email me the answer, Thank you

    Reply
  29. I don’t see any listed coverage for surgery: would a hip replacement be covered? What about General Surgery, like Cholecystectomy, Lumbar Laminectomy?

    Reply
  30. Does Humana Gold Plus HMO plans require authorization and/or referral for a doctors visit?

    Reply
    • You would need to choose a primary care doctor. In most cases, you need a referral for specialists.

      Reply
  31. I am under going radiation treatment for prostate cancer for the last
    month, today I received a bill for co-pay for 30 dollars a treatment,
    for a total for 45 treatment for a grand total of 1,350.00. When i
    started the treatment nothing was said about a co-pay. Friends I know
    had the same treatment last year a paid nothing. 1350.00 dollars is
    a lot of money, and for many people who can not afford that kind of bill.
    When did Humana start this process.

    Reply
    • Please Check with Humana to clear this up.

      Reply
  32. Just received a bill from Piedmont Healthcare in the amount of $103.55. This represents a co-pay for a head CT on 2/8/2016. I have extra help and it was my understanding that this bill would be covered 100%. Is there something I need to do? Thank you. Jan

    Reply
    • Please Check with Humana

      Reply
  33. My dad had a heart attack in January. He has Humana Gold Plus. He is now being told that he is in the “donut hole” for his prescriptions due to the hospital visit. Should the medicines received during this visit go toward medical insurance not pharmacy?

    Reply
  34. I have a cataract that needs to be removed. I am covered by Humana Gold Plus HMO. Is there any financial coverage from this plan?

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  35. I need a list of mental health providers that has this ins coverage

    Reply
  36. Do you cover any type of lap ban surgery?

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  37. I have Humana Gold Plus HMO. I am searching for a provider for Diabetic shoes and a back brace. My zip is 19020 Can anyone help ?

    Reply
  38. How much is 30 day supply Lyrica?

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  39. I need an ophthalmologiiist in or near 19136 zip code can you please help

    Reply
  40. I have humana gold plus am I covered for dental extractions, if not how do I get dental coverage that covers extractions?

    Reply
    • Humana Gold Plus offers Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth). Please Contact Humana directly to verify this.

      Reply
  41. I have Humana Gold Plus HMO and was wondering what health clubs it covers such as YMCA, etc? Thanks you.

    Reply
  42. Is lasik eye surgery for astigmatism covered by Humana Gold Plus Snp plan, plus North Carolina Medicaid as secondary?

    Reply
    • Most insurance companies don’t cover LASIK, because laser eye surgery is nearly always considered an elective or cosmetic surgery.

      Reply
  43. My mother needs cateract surgery with Gold coverage. What do you and Medicare cover? The surgeon has qouted her from $3250 per eye to $1550 per eye. But my best friend just had the same surgery and only paid $35.00, she had Attneda, plan G and Medicare.
    Mom’s sugeon wants her to pay the entire amount before he will perform the surgery

    Reply
  44. Where can I find information about Humana Gold Plus medical coverage outside the USA. What medical and medical emergency is covered? Is there a yearly or lifetime maximum coverage for such service? Is there a maximum of time one can be outside of the USA for coverage to still be available? Where can I find this information in the Humana policy

    Reply
  45. Is there a booklet with Dr. names, specialties, etc. for my area 60061?
    Also need dentist for the same. Thank you

    Where would I get this?

    Reply
  46. I have called Humana multiple times in an attempt to get a list of dental providers included in the new dental benefit (basic dental – check up, cleanings, etc) for Humana Gold Plus H2012-037 for 2017. I am trying to decide between two medicare advantage plans. I have NEVER been able to access that information from Humana and am extremely frustrated. Where is the list of providers for this particular dental plan (part of medical; not a special add-on). I am in the Seattle area. Zip 98026

    Reply

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