2022 Humana Gold Plus H5178-001 (HMO)

Humana Gold Plus H5178-001 (HMO) H5178-001 is a 2022 Medicare Advantage Plan or Part-C by Humana available to residents in South Carolina. This plan includes additional prescription drug (Part-D) coverage. The Humana Gold Plus H5178-001 (HMO) has a monthly premium of $126.00 and has an in-network maximum out-of-pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out-of-pocket. This can be a extremely nice safety net.

Humana Gold Plus H5178-001 (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be 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). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Gold Plus H5178-001 (HMO) 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 you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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1-855-778-4180
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2022 Humana Medicare Advantage Plan Costs

Humana Gold Plus H5178-001 (HMO) Part-C Premium

Humana charges a $83.40 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.

H5178-001 Part-D Deductible and Premium

Humana Gold Plus H5178-001 (HMO) has a monthly drug premium of $42.60 and a $390.00 drug deductible. This Humana plan offers a $42.60 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 $0.00 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 $42.60 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Humana Gap Coverage

In 2022 once you and your plan provider have spent $4430 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 Plus H5178-001 (HMO) medicare insurance offers a $11.50 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $19.30 for 75% low income subsidy $27.00 for 50% and $34.80 for 25%.

H5178-001 Formulary or Drug Coverage

Humana Gold Plus H5178-001 (HMO) 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. You can see complete 2022 Humana Gold Plus H5178-001 (HMO) H5178-001 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$8	$15
Tier 2	$12	$20
Tier 3	25%	25%
Tier 4	25%	25%
Tier 5	26%	26%

*Initial Coverage Phase and 30 day supply

2021 Humana Gold Plus H5178-001 (HMO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	Not covered

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Deductible

Coming soon

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	20% coinsurance
Diagnostic tests and procedures	$0 copay or 20% coinsurance
Lab services	$0 copay or 20% coinsurance
Outpatient x-rays	20% coinsurance

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Doctor Visits

Primary	20% coinsurance per visit
Specialist	20% coinsurance per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	20% coinsurance per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	20% coinsurance
Routine foot care	Not covered

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Ground Ambulance

20% coinsurance

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Hearing

Fitting/evaluation	Not covered
Hearing aids - inner ear	Not covered
Hearing aids - outer ear	Not covered
Hearing aids - over the ear	Not covered
Hearing exam	20% coinsurance

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Inpatient Hospital Coverage

$1,860 per stay

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Medical Equipment/Supplies

Diabetes supplies	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	10% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$1,660 per stay
Outpatient group therapy visit	20% coinsurance
Outpatient group therapy visit with a psychiatrist	20% coinsurance
Outpatient individual therapy visit	20% coinsurance
Outpatient individual therapy visit with a psychiatrist	20% coinsurance

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MOOP

$6,700 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

20% coinsurance per visit

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Preventive Care

$0 copay

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Preventive Dental

Cleaning	Not covered
Dental x-ray(s)	Not covered
Fluoride treatment	Not covered
Oral exam	Not covered

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Rehabilitation Services

Occupational therapy visit	20% coinsurance
Physical therapy and speech and language therapy visit	20% coinsurance

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Skilled Nursing Facility

$0 per day for days 1 through 20 $178 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	Not covered
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	Not covered
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Not covered

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Humana Gold Plus H5178-001 (HMO)

(Click county to compare all available Advantage plans)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.