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. |
I can’t tell from what you wrote about glasses and lenses whether you cover a pair of glasses with lenses for those who haven’t had cataract surgery. Could you please tell me
$0 copay for one pair of eyeglasses or contact lenses after cataract surgery.
What if I don’t have cataracts or the surgery! What’s the cost for glasses or contact lens?,
Is an extraction covered from the dentist?
No. Just routine cleaning and x-rays.
The specialist copay will apply and a discount upto certain amount on glasses and contacts. It varies from plan to plan benefits. For a more accurate amount, you will need to contact a Humana approved facility and inquire for the applicable discounts and rebates,
I have lost my glasses during Hurricane Irma. I have reading glasses. And would like to know where I get my new glasses?
What for it cost for lenses for glasses
I cannot find even 1 optometrist on the list Humana provided that honors this 1 pair of glasses after cataract surgery.My husband needs his glasses.. Please help with this I have been trying to remedy this for weeks now
Try Walmart for his glasses
Walmart does not accept humana insurance
That is incorrect Walmart does take Humana because its a preferred pharmacy in Humana I am glad I am not enrolled in Humana for 2017 I have Care Improvement Plus United Healthcare
went to Walmart and they said that they do not accept Humana for eyeglasses I was told this in Thomasville Alabama and also Fort Smith Arkansas. They do accept Humana for your medications but not eyeglasses
I have this plan. Why am I paying for dental visits and my eyeglasses?
I am an optician for nearly 20 years and this is one of the most confusing insurance coverages for both drs. and patients. Covered glasses means covered up to the allowed amount by Medicare, or Humana, or whatever ins. you have. Those allowed amounts are determined by Medicare and cover 80% of a frame up to $50.00 and a lined bifocal or lined trifocal in standard plastic approximately $45-$48 for lenses. Most optical shops have you pay out of pocket and then the small reimbursement check,usually totally around $145.00, will be sent to you. Any no-line or more expensive frame you will be charged the overage out of pocket. I hope this has helped answer some of your questions.
I am having a hard time understanding and finding the right optician here in Largo, FL.
Thank you!
Did your husband have laser cataract removal?
Is cataract surgery covered? Enrolled in Humana Gold Medicare advantage; is there a co-pay or deductible?
What is the co-pay for cataract surgery at a Ambulatory Surgery Center/
is cateract surgery covered
Yes it’s covered. Call Humana customer service for details.
How much y’all pay on eye glasses each year it was 200 hundred dollars
is.a.pair.of.glasses.covered.without.surgury
I just went thru this for my wife and myself.
They will pay up to 200 dollars toward glasses and frames.
Anything over 200 dollars You pay.
Thanks for sharing.
I was just told today by my eye doctor, they pay for exam, first $100 towards glasses then 20% of what’s left.
THAT’S EXACTLY WHAT HUMANA TOLD ME ONLY 4-5 months ago. I’m GOING TO FIND OUT IN THE MORNING.
Is this insurance, Humana Gold HMO available in PA?
Please Check Your coverage here:
http://www.medicarehelp.org/2017-medicare-advantage/s/pennsylvania
Is Humana gold plus hmo better then Humana advantage
please reply re: cataract surgery coverage
It looks like they pay for the exam once a year but not the glasses. Is that right?
Hi Lana,
…good question. Did you get an answer? $0 copay for one pair of glasses WITHOUT cataract surgery??? yes or no. Please share.
Do you cover glasses and Dentures
The coverage dropped 50% from 2020 to 2021 Now they cover only $50.00 a year for glasses. You must get glasses with the frames. If you use your old frames there is an upcharge. Not very good is it?
Need to see if a tens unit for the lumbar would be cover through my plan, humans gold.
Please see our Formulary tool here.
I receive help in paying my medications. How much will my medications cost on this plan? thank you
You can find your drug prices here.
I just switched over to Humana On January 1st. When I arrived at the office of a specialist whom I had already been seeing I was told that I needed a written referral from my primary care physician. Otherwise I would have to pay full price for the specialist visit. I have read all 4 of my booklets and all of my brochures but cannot find any place that says this is a requirement before seeing a specialist. Why wasn’t I informed of this policy? Was the specialist out of network? Thank you.
This is standard with HMO’s. You are 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). If you need special care your PCP will make the arrangements (written referral) and tell you where you can go in the network.
Yeah for Humana’s Community HMO medicare supplement Plan.
Satisfactory healthcare that was needed is getting attended to thanks. Only just recently found primary-care Physician that reviewed my on-going remedies for the conditions that me, myself has been treated using another HMO that was used the preceeding year. You know, doctor’s office visits can be stressful. This time was better & have been able to go make an appointment & go over each medication with a follow-up requested in 3 months by the Pysician.
Going to the Dentist is for me, myself religiously accomplished on a regular basis. Until now was able to be seen, treated for any maladies & sent on my way through my Spouse’s insurance from work. Unfortunately however, due to personal reasons am no longer covered in that way presently. Disappointed also to find out that the Dentist that was my acquaintance isn’t accepting me as a paying customer using my current Humana Community HMO plan though am me, myself personally funding it. Just now am wondering if the customer service center will be able to help me in locating in the quickest way possible someone inside the system in the same wonderful means that they did my healthcare physician before?
Do you have a list of Dentists that accept Humama?
Thank you.
Sorry, you need to contact Humana. Hopefully we can provide a list in the future.
Will Hummana Gold help pay for a nebula er for breathing
have humana gold plus hmo need dentist inport orange florida 32129 send me list
looking at Medicare supplement plans and wondering what to do. It would be almost $200 per month for a “g” plan but if I don’t do this, a hospitalization or illness scares me due the copays I would have with Humana Gold Plus HMO plan I now have. Do you have a better plan than the current one for me rather than losing me to another company? I just feel a little uncovered with the gold plus hmo due the potential copays if something happens to me. A Medicare supplement seems more prudent, somehow. Any suggestions? MD
Hello, We do not work for or associate with Humana. This website provides details on all Medicare plans. Humana does offer additional options you could also see this plan here: http://www.medicarehelp.org/humana-choice-ppo-plan-details/
Looking for info regarding Humana Gold Medical Plans. I am 61 years old have Medicare and Medicaid. Need doctor care for chronic conditions. Advanced osteoporosis Hep C stage 4 cirrohsis fibromyalgia kidney pain. Vancouver, WA 98661
Humana offers 2 Gold plans in Vancouver see below:
http://www.medicarehelp.org/2016-medicare-advantage/ma/humana-gold-plus-h2012-088-hmo-H2012-088
http://www.medicarehelp.org/2016-medicare-advantage/ma/humana-gold-plus-h2012-031-hmo-H2012-031
Debra, stay away from any Medicare Advantage Plans! For a VERY FEW who are healthy they can be a poor option. For anyone with serious medical issues – they are DEADLY! Stay with Original Medicare. When you sign up with one of these plans they take you out of original medicare and you lose your ability to go to any/all medicare doctors, hospitals, specialists and so forth. EVERYTHING you do has to be done via referrals from your primary. Don’t need that on Original. I just withdrew my Mother and reverted back to Original Medicare. She needed a specialist but could not get discharged from the hospital long enough to get to her Primary Doc to get a referal for the Specialist to schedule her to go back in the hospital? Even though she is currently in said hospital now. Please research this as you will find hundreds of these stories on line, just like mine. We got LUCKY in being able to revert back to Original Medicare in time or she would be dead from WAITING and being recycled around the system and subject to Bean Counter Case Workers making medical decisions based on profit and not proper care. Please reconsider for your own sake!
Thank you for your reply. I have been considering that very thing by not continuing with Humana or any other company. I had a problem with my husbands when he was sick and needed to be transferred to the Veterans hospital. We had Care More then. I was told that Care More owned him, because we had their coverage. I replied they did not own my husband, because he was a veteran and being treated at the VA, and when he signed up for the Military he became property of the United States Government. If they continued, they would have to answer to the Government. He was released the next day. That was a awake up call, I changed to Humana thinking it would be better, only to find that it is not. Now I am thinking of just going back to straight Medicare. Your reply has helped me make that decision. I have no major medical problems that would cause me to have to go to a Dr consistently. I see a Dr. very rarely. My question is I hear that a lot of Drs. do not want to take Medicare patients without a insurance type coverage. Is that a problem? I travel a lot so I need to be able to go to any Dr.if needed. Also do you have to wait until the renewal period to change back to regular medicare?
Anyways, Thank You for your input. You did help someone.
My mom has the Human Gold Plus plan. Does the plan cover transportation from our home to her senior day care facility. She has dementia and goes to the facility Mon-Fri.
Thank you.
Gloria Mick
Yes.
Need info on broken bottom plate.Will insurance help pay to fix it?
Get assistance
HumanaDental
1-800-232-2006
8 a.m. – 6 p.m., Monday – Friday
I have a prescription for my husbands glasses after cataract surgery.Unfortunatly all the names Humana provided do not honor the 0 copay under the regular medicare as stated in the book Humana provided They only except the Eye Med Discount.. How do I find someone to honor what is written in our book of services?
What hospitals are covered under Humana Gold Plus Plans…I live in zip code 34688
Sorry we do not have a provider list. You can see one at Humana’s website here:
https://www.humana.com/finder/medical?pageId=027456a8780a4daabc5fce8aa4a0bd04
today I bought a extra coverage from my humana agent. at top of page it says guarantee trust life insurance company…and it is for hospital confinement benefit 300.00 per day. $62.65 is suppose to come out of my checking account each month. do I need this extra? or will medicare and my humana gold plus be enough for a hospital stay?
Humana’s inpatient hospital Care coverage: (Your plan may vary)
Days 1 – 7: $175 copay per day; Days 8 – 90: $0 copay per day; $0 copay for each additional hospital day.
I am planning to write about the service I have received for the last two years from Apria which is over 50 miles from my house. I want to change to my previous service which is one Block from me. How do I do this and who do I have to write> I am presently covered with Humana Gold Plus (HMO)
To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. You’ll be disenrolled automatically from your old plan when your new plan’s coverage begins.
I have Humana insurance and was told by a rep. that I had a monthly benefit for over-the-counter drugs ordered from Humana pharmacy. How do I find out if this is true and how much is the benefit?
Please contact Humana
I have the Humana plan that offers the over the counter benefit thru their mail order pharmacy. For 2015, we are allowed $30.00 per month, shipping is free. If we order more than $30.00, we the policy holder, is responsible for the difference. They provide a booklet of items available or you can order online. Hope this helps.
Thank you for Sharing!
It is currently now $50 a quarter.