2021 Humana Gold Choice H8145-061 (PFFS) H8145-061 By Humana.

Summary of Benefits for
2021 Humana Gold Choice H8145-061 (PFFS)


Humana Gold Choice H8145-061 (PFFS) H8145-061 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Humana available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The Humana Gold Choice H8145-061 (PFFS) has a monthly premium of $101.00 and has an in-network Maximum Out-of-Pocket limit of $- (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $- out of pocket. This can be a extremely nice safety net.

Humana Gold Choice H8145-061 (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 (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.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Gold Choice H8145-061 (PFFS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.




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2021 Humana Medicare Advantage Plan Costs

Name:
Humana Gold Choice H8145-061 (PFFS)
Plan ID:
H8145-061
Provider:Humana
Year:2021
Type: PFFS
Monthly Premium C+D: $101.00
Part C Premium: $59.60
MOOP: $-
Part D (Drug) Premium: $41.40
Part D Supplemental Premium $0
Total Part D Premium: $41.40
Drug Deductible: $200.0
Tiers with No Deductible:1
Gap Coverage:No
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H8145-069




Humana Gold Choice H8145-061 (PFFS) Part-C Premium

Humana plan charges a $59.60 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.



H8145-061 Part-D Deductible and Premium

Humana Gold Choice H8145-061 (PFFS) has a monthly drug premium of $41.40 and a $200.0 drug deductible. This Humana plan offers a $41.40 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 $0 this Premium covers any enhanced plan benefits offered by Humana 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 $41.40. 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.



Humana Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Humana plan does not offer additional coverage through the gap.



Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Humana Gold Choice H8145-061 (PFFS) medicare insurance offers a $10.60 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $18.30 for 75% low income subsidy $26.00 for 50% and $33.70 for 25%.



Full LIS Premium: $10.60
75% LIS Premium: $18.30
50% LIS Premium: $26.00
25% LIS Premium: $33.70


H8145-061 Formulary or Drug Coverage

Humana Gold Choice H8145-061 (PFFS) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 $7 $10
Tier 2 $17 $20
Tier 3 $47 $47
Tier 4 $97 $100
Tier 5 29% 29%
*Initial Coverage Phase and 30 day supply







2021 Humana Gold Choice H8145-061 (PFFS) Summary of Benefits




Additional Benefits


No



Comprehensive Dental


Diagnostic services Not covered
Endodontics Not covered
Extractions 50% coinsurance (Out-of-Network)
Extractions $0 copay
Non-routine services Not covered
Periodontics $0 copay
Periodontics 50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services 50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay
Restorative services 50% coinsurance (Out-of-Network)
Restorative services $0 copay



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $40-150 copay or 20-25% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI) $40-150 copay or 20-25% coinsurance
Diagnostic tests and procedures $0-40 copay or 20-25% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0-40 copay or 25% coinsurance
Lab services $0-40 copay or 25% coinsurance
Lab services $0-40 copay or 20-25% coinsurance (Out-of-Network)
Outpatient x-rays $5-40 copay or 20-25% coinsurance
Outpatient x-rays $0-40 copay or 20-25% coinsurance (Out-of-Network)



Doctor Visits


Primary $5 copay per visit (Out-of-Network)
Primary $5 copay per visit
Specialist $40 copay per visit (Out-of-Network)
Specialist $40 copay per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $5-40 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $40 copay
Foot exams and treatment $40 copay (Out-of-Network)
Routine foot care Not covered



Ground Ambulance


$240 copay
$240 copay (Out-of-Network)



Hearing


Fitting/evaluation $0 copay
Fitting/evaluation 50% coinsurance (Out-of-Network)
Hearing aids $0 copay
Hearing aids $0 copay (Out-of-Network)
Hearing exam $40 copay (Out-of-Network)
Hearing exam $40 copay



Inpatient Hospital Coverage


$290 per day for days 1 through 5
$0 per day for days 6 through 90 (Out-of-Network)
$290 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond



Medical Equipment/Supplies


Diabetes supplies 20% coinsurance per item (Out-of-Network)
Diabetes supplies $0 copay or 20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


Chemotherapy 20% coinsurance (Out-of-Network)
Chemotherapy 20% coinsurance
Other Part B drugs 20% coinsurance
Other Part B drugs 20% coinsurance (Out-of-Network)



Mental Health Services


Inpatient hospital - psychiatric $285 per day for days 1 through 5
$0 per day for days 6 through 90 (Out-of-Network)
Inpatient hospital - psychiatric $285 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit $40 copay (Out-of-Network)
Outpatient group therapy visit $40 copay
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient group therapy visit with a psychiatrist $40 copay (Out-of-Network)
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit $40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay



MOOP


$6,700 In and Out-of-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$40-150 copay or 20-25% coinsurance per visit (Out-of-Network)
$40-150 copay or 25% coinsurance per visit



Preventive Care


$0 copay (Out-of-Network)
$0 copay



Preventive Dental


Cleaning $0 copay
Cleaning 50% coinsurance (Out-of-Network)
Dental x-ray(s) 50% coinsurance (Out-of-Network)
Dental x-ray(s) $0 copay
Fluoride treatment Not covered
Oral exam 50% coinsurance (Out-of-Network)
Oral exam $0 copay



Rehabilitation Services


Occupational therapy visit $40 copay or 20-25% coinsurance
Occupational therapy visit $40 copay or 20-25% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit $40 copay or 20-25% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit $40 copay or 20-25% coinsurance



Skilled Nursing Facility


$0 per day for days 1 through 20
$150 per day for days 21 through 100
$0 per day for days 1 through 20
$150 per day for days 21 through 100 (Out-of-Network)



Transportation


Not covered



Vision


Contact lenses $0 copay
Contact lenses $0 copay (Out-of-Network)
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) $0 copay
Eyeglasses (frames and lenses) $0 copay (Out-of-Network)
Other Not covered
Routine eye exam $0 copay
Routine eye exam $0 copay (Out-of-Network)
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




Reviews for Humana Gold Choice H8145-061 (PFFS) H8145



2019 Overall Rating
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


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer 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
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Humana Gold Choice H8145-061 (PFFS) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals


Health Plan Customer Service Rating for Humana Gold Choice H8145-061 (PFFS)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Humana Gold Choice H8145-061 (PFFS) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes



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Or Call
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Sun 9am-6pm EST




Coverage Area for Humana Gold Choice H8145-061 (PFFS)

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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