2016 Medicare Advantage Humana Gold Choice H8145-123 (PFFS)
Humana Gold Choice H8145-123 (PFFS) H8145-123 is a 2016 Medicare Advantage or Medicare Part-C plan by Humana Insurance Company available to residents in Colorado New Mexico. This plan includes additional Medicare prescription drug (Part-D) coverage. The Humana Gold Choice H8145-123 (PFFS) has a monthly premium of $98.00 and has a in-network Maximum Out-of-Pocket limit of N/A (MOOP). This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket N/A this can be a very nice safety net.
Humana Gold Choice H8145-123 (PFFS) is a PFFS. A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan offered by a contract with the Centers for Medicare & Medicaid Services (CMS) to provide you with benefits. Humana Insurance Company (instead of Medicare) will decide on how much it will cover and how much you will pay for the services you get. You may go to any Medicare approved doctor or hospital or any other health care provider that accepts both Medicare and your plans payment. A PFFS plan has no provider network, and you dont need a referral or a primary care physician for any health care or services. PFFS plans are the most flexible but a doctor will make a visit-by-visit decisions on whether to accept your provider.
This plan from Humana Insurance Company works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Gold Choice H8145-123 (PFFS) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Humana Insurance Company and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
2016 Humana Insurance Company Medicare Advantage Plan Details
Plan Name: | Humana Gold Choice H8145-123 (PFFS) |
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Plan ID: | H8145-123 |
Provider: | Humana Insurance Company |
Parent: | Humana Inc. |
Plan Year: | 2016 |
Plan Type: | PFFS |
Monthly Premium C+D: | $98.00 |
MOOP: | N/A |
Plan Services
Monthly premium deductible and limits on how much you pay for covered services
- $6 700 for services you receive from any provider.
Doctor's office visits
- In-network: $15 copay
- Out-of-network: $15 copay
- In-network: $50 copay
- Out-of-network: $50 copay
Durable medical equipment (wheelchairs oxygen etc.)
- In-network: 20% of the cost
- Out-of-network: 25% of the cost
Emergency care
Foot care (podiatry services)
- In-network: $50 copay
- Out-of-network: $50 copay
Hearing services
- In-network: $50 copay
- Out-of-network: $50 copay
Home health care
- In-network: You pay nothing
- Out-of-network: You pay nothing
Mental health care
- In-network:
- $300 copay per day for days 1 through 5
- You pay nothing per day for days 6 through 90
- Out-of-network:
- $300 copay per day for days 1 through 5
- You pay nothing per day for days 6 through 90
- In-network: $40 copay
- Out-of-network: $40 copay
- In-network: $40 copay
- Out-of-network: $40 copay
Outpatient rehabilitation
- In-network: $50 copay
- Out-of-network: $50 copay
- In-network: $40 copay
- Out-of-network: $40 copay
- In-network: $40 copay
- Out-of-network: $40 copay
Outpatient substance abuse
- In-network: $40-100 copay depending on the service
- Out-of-network: $40-100 copay depending on the service
- In-network: $40-100 copay depending on the service
- Out-of-network: $40-100 copay depending on the service
Outpatient surgery
- In-network: 20% of the cost
- Out-of-network: 25% of the cost
- In-network: 25% of the cost
- Out-of-network: 25% of the cost
Acupuncture
Over-the-counter items
Prosthetic devices (braces artificial limbs etc.)
- In-network: 20% of the cost
- Out-of-network: 25% of the cost
- In-network: 20% of the cost
- Out-of-network: 25% of the cost
Renal dialysis
- In-network: 20% of the cost
- Out-of-network: 20% of the cost
Transportation
Urgently needed services
Vision services
- In-network: $0-50 copay depending on the service
- Out-of-network: $0-50 copay depending on the service
- In-network: You pay nothing. You are covered for up to 1 every year.
- Out-of-network: You pay nothing. There may be a limit to how often these services are covered.
- In-network: $25 copay
- Out-of-network: $25 copay
Preventive care
- In-network: You pay nothing
- Out-of-network: You pay nothing
- Abdominal aortic aneurysm screening
- Alcohol misuse counseling
- Bone mass measurement
- Breast cancer screening (mammogram)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular screenings
- Cervical and vaginal cancer screening
- Colorectal cancer screenings (Colonoscopy Fecal occult blood test Flexible sigmoidoscopy)
- Depression screening
- Diabetes screenings
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
- "Welcome to Medicare" preventive visit (one-time)
- Yearly "Wellness" visit
Hospice
Inpatient hospital care
- In-network:
- $325 copay per day for days 1 through 5
- You pay nothing per day for days 6 through 90
- You pay nothing per day for days 91 and beyond
- Out-of-network:
- $325 copay per day for days 1 through 5
- You pay nothing per day for days 6 through 90
Inpatient mental health care
Skilled Nursing Facility (SNF)
- In-network:
- You pay nothing per day for days 1 through 20
- $160 copay per day for days 21 through 100
- Out-of-network:
- You pay nothing per day for days 1 through 20
- $160 copay per day for days 21 through 100
Outpatient prescription drugs
- In-network: 20% of the cost
- Out-of-network: 25% of the cost
- In-network: 20% of the cost
- Out-of-network: 25% of the cost
Tier | One-month supply | Three-month supply |
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Tier 1 (Preferred Generic) | $7 copay | $21 copay |
Tier 2 (Generic) | $15 copay | $45 copay |
Tier 3 (Preferred Brand) | $47 copay | $141 copay |
Tier 4 (Non-Preferred Brand) | $100 copay | $300 copay |
Tier 5 (Specialty Tier) | 26% of the cost | Not Offered |
Tier | One-month supply | Three-month supply |
---|---|---|
Tier 1 (Preferred Generic) | $7 copay | $21 copay |
Tier 2 (Generic) | $15 copay | $45 copay |
Tier 3 (Preferred Brand) | $47 copay | $141 copay |
Tier 4 (Non-Preferred Brand) | $100 copay | $300 copay |
Tier 5 (Specialty Tier) | 26% of the cost | Not Offered |
Tier | One-month supply | Three-month supply |
---|---|---|
Tier 1 (Preferred Generic) | $7 copay | $0 |
Tier 2 (Generic) | $15 copay | $0 |
Tier 3 (Preferred Brand) | $47 copay | $131 copay |
Tier 4 (Non-Preferred Brand) | $100 copay | $290 copay |
Tier 5 (Specialty Tier) | 26% of the cost | Not Offered |
You may get drugs from an out-of-network pharmacy but may pay more than you pay at an in-network pharmacy.
Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means that there's a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $3 310.
After you enter the coverage gap you pay 45% of the plan's cost for covered brand name drugs and 58% of the plan's cost for covered generic drugs until your costs total $4 850 which is the end of the coverage gap. Not everyone will enter the coverage gap.
Under this plan you may pay even less for the brand and generic drugs on the formulary. Your cost varies by tier. You will need to use your formulary to locate your drug's tier. See the chart that follows to find out how much it will cost you.Standard Retail Cost-Sharing
Tier | Drugs Covered | One-month supply | Three-month supply |
---|---|---|---|
Tier 1 (Preferred Generic) | Some | $7 copay | $21 copay |
Tier 2 (Generic) | Some | $15 copay | $45 copay |
Tier 3 (Preferred Brand) | Some | $47 copay | $141 copay |
Tier 4 (Non-Preferred Brand) | Some | $100 copay | $300 copay |
Tier 5 (Specialty Tier) | Some | 26% of the cost | Not Offered |
Tier | Drugs Covered | One-month supply | Three-month supply |
---|---|---|---|
Tier 1 (Preferred Generic) | Some | $7 copay | $21 copay |
Tier 2 (Generic) | Some | $15 copay | $45 copay |
Tier 3 (Preferred Brand) | Some | $47 copay | $141 copay |
Tier 4 (Non-Preferred Brand) | Some | $100 copay | $300 copay |
Tier 5 (Specialty Tier) | Some | 26% of the cost | Not Offered |
Tier | Drugs Covered | One-month supply | Three-month supply |
---|---|---|---|
Tier 1 (Preferred Generic) | Some | $7 copay | $0 |
Tier 2 (Generic) | Some | $15 copay | $0 |
Tier 3 (Preferred Brand) | Some | $47 copay | $131 copay |
Tier 4 (Non-Preferred Brand) | Some | $100 copay | $290 copay |
Tier 5 (Specialty Tier) | Some | 26% of the cost | Not Offered |
- 5% of the cost or
- $2.95 copay for generic (including brand drugs treated as generic) and a $7.40 copayment for all other drugs.
Ambulance
- In-network: $300 copay
- Out-of-network: $300 copay
Chiropractic care
- In-network: $20 copay
- Out-of-network: $40 copay
Dental services
- In-network: $50 copay
- Out-of-network: $50 copay
- In-network: You pay nothing. You are covered for up to 1 every year.
- Out-of-network: 50% of the cost
- In-network: You pay nothing. You are covered for up to 1 every year.
- Out-of-network: 50% of the cost
- In-network: You pay nothing. You are covered for up to 1 every year.
- Out-of-network: 50% of the cost
Diabetes supplies and services
- In-network: 0-20% of the cost depending on the supply
- Out-of-network: 25% of the cost
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: $10 copay
- Out-of-network: 25% of the cost
Diagnostic tests lab and radiology services and x-rays (Costs for these services may be different if received in an outpatient surgery setting)
- In-network: $50-275 copay or 20-25% of the cost depending on the service
- Out-of-network: $50-275 copay or 25% of the cost depending on the service
- In-network: $0-100 copay or 25% of the cost depending on the service
- Out-of-network: $0-100 copay or 25% of the cost depending on the service
- In-network: $0-50 copay depending on the service
- Out-of-network: $0-50 copay depending on the service
- In-network: $15-100 copay depending on the service
- Out-of-network: $15-100 copay depending on the service
- In-network: $50 copay or 20% of the cost depending on the service
- Out-of-network: $50-275 copay or 25% of the cost depending on the service
Coverage Area for Humana Gold Choice H8145-123 (PFFS)
(Click county to compare all available plans)
Ratings for Humana Gold Choice H8145-123 (PFFS) H8145
2016 Overall Rating | ||
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Part C Summary Rating | ||
Part D Summary Rating | ||
Staying Healthy: Screenings, Tests, Vaccines | ||
Managing Chronic (Long Term) Conditions | ||
Member Experience with Health Plan | ||
Complaints and Changes in Plans Performance | ||
Health Plan Customer Service | ||
Drug Plan Customer Service | ||
Complaints and Changes in the Drug Plan | ||
Member Experience with the Drug Plan | ||
Drug Safety and Accuracy of Drug Pricing |
Member Experience with Health Plan
Total Experience Rating | ||
---|---|---|
Getting Needed Care | ||
Timely Care and Appointments | ||
Customer Service | ||
Health Care Quality | ||
Rating of Health Plan | ||
Care Coordination |
Member Complaints and Changes in Humana Gold Choice H8145-123 (PFFS) Plans Performance
Total Rating | ||
---|---|---|
Members Leaving the Plan | ||
Complaints about Health Plan | ||
Beneficiary Access | ||
Health Plan Quality Improvement |
Health Plan Customer Service Rating for Humana Gold Choice H8145-123 (PFFS)
Total Customer Service Rating | ||
---|---|---|
Timely Decisions About Appeals | ||
Reviewing Appeals Decisions | ||
Call Center, TTY, Foreign Language |
Staying Healthy, Screening, Testing, & Vaccines
Total Preventative Rating | ||
---|---|---|
Breast Cancer Screening | ||
Colorectal Cancel Screening | ||
Annual Flu Vaccine | ||
Improving Physical | ||
Improving Mental Health | ||
Monitoring Physical Activity | ||
Adult BMI Assessment |
Managing Chronic And Long Term Care for Older Adults
Total Rating | ||
---|---|---|
SNP Care Management | ||
Medication Review | ||
Functional Status Assessment | ||
Pain Screening | ||
Osteoporosis Management | ||
Diabetes Care - Eye Exam | ||
Diabetes Care - Kidney Disease | ||
Diabetes Care - Blood Sugar | ||
Controlling Blood Pressure | ||
Rheumatoid Arthritis | ||
Improving Bladder Control | ||
Reducing Risk of Falling | ||
Plan - Cause Readmissions |
Member Experience with the Drug Plan
Total Rating | ||
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Rating of Drug Plan | ||
Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
Total Rating | ||
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MPF Price Accuracy | ||
High Risk Medication | ||
Drug Adherence for Diabetes Medications | ||
Drug Adherence for Hypertension (RAS antagonists) | ||
Drug Adherence for Cholesterol (Statins) | ||
MTM Program Completion Rate for CMR |
Ratings For Member Complaints and Changes in the Drug Plans Performance
Total Rating | ||
---|---|---|
Complaints about the Drug Plan | ||
Members Choosing to Leave the Plan | ||
Beneficiary Access | ||
Drug Plan Quality Improvement |
Humana Gold Choice H8145-123 (PFFS) Drug Plan Customer Service ratings
Total Rating | ||
---|---|---|
Appeals Auto Forward | ||
Appeals Upheld | ||
Call Center, TTY, Foreign Language |
Part-C Premium
Humana Insurance Company plan charges a $57.30 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
The Humana Gold Choice H8145-123 (PFFS) plan has a monthly drug premium of $35.20 and a $300.00 drug deductible. This Humana Insurance Company plan offers a $35.20 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $5.50 this Premium covers any enhanced plan benefits offered by Humana Insurance Company above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $40.70. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Premium Assistance
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Humana Gold Choice H8145-123 (PFFS) medicare insurance plan offers a $14.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $20.60 for 75% low income subsidy $27.30 for 50% and $34.00 for 25%.
Part C Premium: | $57.30 |
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Part D (Drug) Premium: | $35.20 |
Part D Supplemental Premium | $5.50 |
Total Part D Premium: | $40.70 |
Drug Deductible: | $300.00 |
Tiers with No Deductible: | 1 |
Benchmark: | not below the regional benchmark |
Type of Medicare Health Plan: | Enhanced Alternative |
Drug Benefit Type: | Enhanced |
Full LIS Premium: | $14.00 |
75% LIS Premium: | $20.60 |
50% LIS Premium: | $27.30 |
25% LIS Premium: | $34.00 |
Gap Coverage: | Yes |
Gap Coverage
In 2016 once you and your plan provider have spent $3,310 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 45% for brand-name drugs and 58% on generic drugs unless your plan offers additional coverage. This Humana Insurance Company plan does offer additional coverage through the gap.
Source: CMS.
Plans as of September 9, 2015.
Star Rating as of September 30, 2015.
For More Information on Ratings Please See the CMS Tech Notes Here.
Notes: Data are subject to change as contracts are finalized. For 2016, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit
Includes 2016 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.