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. |
Question, going to retire early with no social security for now, moving to Florida. We are 62 and 63, do we need to be on social security of medicare before we can acquire insurance in Florida? In California we have the Kaiser plan HMO.
Humana hmo cover outside of the state i livve in
Do I need a referral for Dermatologist?
Do I need referrals for all specialists?
I called to place an order on 7-7-20 with one of the medications being Lantus Solostar and quoted a price of $30. FOR A 3 month supply that I order thru the mail. I called today to check the status of my order and was told the Lantus was cancelled. I called customer service to find out why and was told it was because of the co-payment of $218. i was asking what happened to the $30 co-pay and asked to speak to a manager who said the co-pay was $131 for the 3 month supply. She then transferred me to a manager who then informed me my c0-pay would be $618 because of the coverage gap! I was afraid to speak to anybody else fearing I would soon owe over a $1000 or more. Ileft HMSA last year hoping your company would be a better experience but so far i will start checking on another company. Can SOMEBODY with tour co. get the right information the first time or at least honor the prices you quote as I can see now you prefer a $200000 hospital bill as I will not pay your demands and stop taking this med and get sick and land in the hospital with this ENORMOUS bill instead of honoring what I was quoted.All I ask is too honor the price I was quoted.
I just signed up for HMO GOLD. What is the difference from HMO GOLD PLUS?
Does my Humana gold plus plan cover rides to doctors appointments?
Where do I go in order to get transportation for a doctor visit. Thank you, Joan
If I have Humana Gold Plus (hmo snp) Dental Insurance and QMB Extra Help (Medicaid Pays my Medicare Premium.. am I responsible for paying my In Network Dentist for a tooth Extraction and $15 dollars for what they call Unspecified Preventive Procedure because of Covid QMB. And if more than 1 tooth requires Filling am responsible the others and if I require a deep Cleaning am responsible for the cost out of pocket also.
I broke my ankle about 2 years ago and my doctor who is an orthopedic surgeon did surgery on my ankle. I have had to see this doctor quite a bit since that time. Since I changed to Humana, I am now having to pay a co pay, which at age 83 and on limited income can be costly for me. Since he is my ortheopedic doctor taking care of my ankle, I feel there should be some exceptions regarding co pays since he is considered a specialist in humanns’ eyes.
I will be having cataract surgery on both eyes. What does my Gold plus
policy pay?
I will be having cataract surgery on both eyes(right for distance and left for near; what will my Gold Plus HMO policy cover. Thank you…..
Does Humana Gold provide home health care for seniors?
As a member of Humana Gold HMO I would like to know how much Humana pay for glasses (lens and frame)
Does Humana Gold Plus cover or offer vitamins?
I am already a member of Humana Choice and have been since 2012 and thought I was approved for extra help and was told I hadn’t had any help since 2015 .But I have been getting statements telling me I was approved.
vitamin D checkup needed
I have a prescription for my eyeglasses. Does Humana gold HMO pay for lenses and frames? If so how much.
so for me starting in July, I live in Maine…transportation is provided one way with a 15 mile limit