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. |
My parents are on Humana Gold Plus HMO. What kind of help does this do for my mother if we should have to put my father in assisted living or a skilled nursing home permanently?
I am a member of HumanaCHOICE(PPO D-SNP) A Medicare Health Plan with Prescription Drug Coverage
Everywhere I have read it is said that Prostatic Wigs are not covered. When I enrolled I was told that it was. That is why I got the plan. I have cancer and I have had chemo and radiation. And my hair is ruined from it all, my hair is thin and I have bald spots and that is why I wear wigs. I hope that I was not misled about this plan. Any information I can get would be helpful. Thank You for your time.
Hi i am a Humana Gold Plus customer and i would like a list of Podiatrist in the Sun City West area 85375 that would be covered on my current plan. Thank you….
How can I find a list of in-network dental Providers in the Columbus, Ohio area?
Medigap HD Plan G sounds like a good plan unless you are in one of those states that gives you the option of changing a Medigap plan without underwriting at a specific time of the year – like on your birthday –
Many of them have the stipulation that you can only change to an equal or lesser plan – in this case, Medigap HD Plan G is pretty low on the scale.
This only matters if it involves you and your state’s options.
My wife was talking with a Humana Medicare Customer Service Rep regarding coverage for a tetanus shot. She was told that she has two options: 1) Have a covered pharmacy administer the shot (which make sense), or 2) if she wanted her physician to administer it she would have to purchase the vaccine from a covered pharmacy, take it to the physician and have them administer it (which makes absolutely no sense). Has anyone else encountered this? Right now, I am assuming the Customer Service Rep doesn’t know what they are talking about, but then again, we are new to Medicare. Thanks for any help on this.
Already have had them for years. They are excellent. Large # of doctor, great pharmacy co-pay prices. There is a hick up with the Android app. But it’s getting better.
My wife and I have a traditional Medicare plan with a United Healthcare supplement F plan and a prescription D plan. I have had three blood clot situations and spent a week each in the hospital and it cost me nothing and my doctor visits cost me nothing. The only problem we have had is that my prescription plan puts me in the doughnut hole for half the year.
When my wife and I hit the age we opted for an advantage plan as it was no additional cost and we do not have any medical needs currently. I realize that as we age, we will start to develop some medical problems, but we were going to switch over to a full supplemental plan in a couple of years, which is an additional $200 per month. I was told we should fly through any underwriting background check.
My brother in Texas has advantage, he went in for something else and the doctor immediately sent him to the hospital his artery in his neck was about to burst. My girlfriend has the supplemental and she has gone to the emergency a few times with stomach problems, and they don’t do anything. I think I’ll stay with my advantage plan. If they aren’t going to help when in pain, I will only pay when needed.
What is the maximum amount that a plan can increase per year?
What about MSAs?
I have zero health conditon, and no drugs.
The secret: zero processed food and good dose of exercise. In my 70s by now.
Hiking in altitude 20 miles: no problem.
Medicare Advantage is trying to ruin the Medicare program.
Again America’s supplement program cost you anywhere from 3 to $500 a month Most people that’s a life changing difference it’s great to be rich and have great retirement and great insurance but then there are the rest of us you’re a little biased
What Medicare supplement has a good dental plan?