2014 Humana Gold Choice H8145-049 (PFFS) H8145-049 By Humana Insurance Company

Humana Gold Choice H8145-049 (PFFS) By Humana Insurance Company

Humana Gold Choice H8145-049 (PFFS) is a 2014 Medicare Advantage ("Part C" or "MA Plan") plan by Humana Insurance Company. 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 H8145-049 (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.

2014 Medicare Advantage Plan Details

Plan Name:
Humana Gold Choice H8145-049 (PFFS)
Plan ID:
Provider: Humana Insurance Company
Plan Year:2014
Plan Type: PFFS
Monthly Premium C+D: $85.00

Coverage Area for Humana Gold Choice H8145-049 (PFFS)

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The Humana Gold Choice H8145-049 (PFFS) H8145-049 is available to residents in West Virginia, 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. If you enroll in Humana Gold Choice H8145-049 (PFFS) plan you will stop paying co-pays for the rest of the year once you pay out of pocket N/A This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.

Humana Gold Choice H8145-049 (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.

Ratings for Humana Gold Choice H8145-049 (PFFS) H8145

2014 Overall Rating
Part C Summary Rating
Total Experience Rating
Complaints, Improvements
Total Customer Service Rating
Total Preventative Rating
Chronic And Long Term Care

Member Experience Rating for Humana Gold Choice H8145-049 (PFFS)

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

Member Complaints, Problems Getting Service and Improvements in Health Plans

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Access to Service
Performance Problems
Health Plan Quality Improvement

Customer Service Rating for Humana Gold Choice H8145-049 (PFFS)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancel Screening
Cardiovascular Screening
Diabetes Care
Glaucoma Testing
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Ratings For Managing Chronic And Long Term Care

Total Rating
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Diabetes Care - Cholesterol
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions

Part-C Premium

Humana Insurance Company plan charges a $44.10 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 H8145-049 (PFFS) plan has a monthly drug premium of $35.00 and a $0.00 drug deductible. This Humana Insurance Company plan offers a $35.00 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 $5.90 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 $40.90. 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 H8145-049 (PFFS) medicare insurance plan offers a $5.90 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $14.60 for 75% low income subsidy $23.40 for 50% and $32.10 for 25%.

Part C Premium: $44.10
Part D (Drug) Premium: $35.00
Part D Supplemental Premium $5.90
Total Part D Premium: $40.90
Drug Deductible: $0.00
Tiers with No Deductible: 0
Benchmark: not below the regional benchmark
Type of Medicare Health Plan: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $5.90
75% LIS Premium: $14.60
50% LIS Premium: $23.40
25% LIS Premium: $32.10
Inital Coverage Limit:$2850
Gap Coverage: Few Generics, Few Brands

Gap Coverage

In 2014 once you and your plan provider have spent $2,850 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be require to pay 47.5% of the plan's cost for covered brand-name prescription drugs and 72% of the cost for generic drugs unless your plan offers additional coverage. This Humana Insurance Company plan offers Few Generics, Few Brands through the gap. Few means 0% to 10% of the formulary drugs are covered if your are in the gap and must also be greather then 15 "brand" products covered through the gap.

Source: CMS.

Plans as of September 3, 2013.

Star Rating as of September 27, 2013.

For More Information on Ratings Please See the CMS Tech Notes Here.

Plans are subject to change as contracts are finalized.

Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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