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.

205 Comments

  1. I have Humana Gold Plus HMO and how much would I have to pay for cataract surgery?

    Reply
    • I have humana gold plus hmo and how much would I have to pay for cataract surgery

      Reply
  2. What is the cost of radiation therapy for breast cancer

    Reply
    • Does Humana Gold pay for a family member to stay home and care for an elderly parent?

      Reply
  3. DO I have a plan D with my policy? H49958729

    Reply
  4. What does advantage hmo plus gold pay for knee replacement?

    Reply
  5. I have Humana GoldPlus, do I need a referral for pain management?

    Reply
    • So I have Humana Gold Choice with partial network coverage. One what exactly does that mean? I also have a Medicare card that’s says plan A and B. Does this cover long term care if I were to enter a nursing home?

      Reply
  6. What about Silver Sneaker program and travel to and from dental and doctors appointment if a spouse is working or can’t drive due to their illness

    Reply
    • Dental for 2020

      Reply
    • I have Medicaid, and Humana Gold Plus HMO D-SNP, I guess that tells you I have Medicaid, Medicare part a, b, c, d and extra help…. I have everything. I don’t pay my spindown because I can’t afford to. My question is: am I still qualified for the silver sneakers program? I know I could call the gym, but I came across this discussion.
      Thanks

      Reply
  7. I have Humana GoldPlus, do I have to pay the 20% coinsurance that Medacare does not pay of dialysis or does Humana pay this 20%?

    Reply
  8. I take APAP/CODEINE TAB 300-60MG 2 daily. What will I pay for the same with Humana Gold Plus Plan for a month?

    Reply
  9. does humana gold cover silver sneakers for 2020

    Reply

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