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 received a list of HCA hospitals that accept Humana Gold Plus.
I live in Miami. Is Mt. Sinai Hospital covered by my plan
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
wanting to know more about the sneaker program, how to get in to a complete program
Please see here: https://www.silversneakers.com/
I lost my Humana Gold Plus reference book that lists the doctors, etc. in my area that I can use.
Please tell me how to get a new one mailed to me because I have tried for hours to find a phone # on line and all I get is recordings that have nothing to do with what I need. PLEASE help me. Susan Surla
Sign in to MyHumana (https://www.humana.com/logon) and send them an email.
What is the co-pay for therapy on Humana Gold Plus (HMO)? And what is the co-pay on pain injections?
The standard co-pay.
Will Humana HMO Gold Plus pay for NEW Dentures?
Thank you!
This plan offers limited dental services. Check with Humana to see.
Do you have a plan that covers extraction and dentures
Both I and my ex-husband have Humana Gold Plus. I moved him into my house to care for him. He is Bi-polar, has frontal lobe dementia and early stage Alzheimers. Can I get paid for “Home Healthcare” under our Humana Plan since he requires a Caregiver?
My father needs cataract surgery and I am trying to find out what Humana gold covers for that. Medicare has told me that it covers a standard 80%
Yes
Is this Humana Gold Plus for Seniors availble in Lauderdale County Alabama?
Yes, here is the plan details:
http://www.medicarehelp.org/2016-medicare-advantage/ma/humana-gold-plus-h2012-097-hmo-H2012-097
Looking for additional dental benefits (supplement) to add to my Humana Gold HMO plan
I am trying to help my neighbor find an appropriate inpatient memory care center for his wife who has rapidly deteriorating Alzheimer’s disease. She has become too ill (mentally and physically) for him to continue caring for her at home but doesn’t know where to start. Will his Humana Gold Plus HMO pay for an inpatient facility for her?
You may want to consider a SNP (Special Needs Plans) with institutionalized individuals (individuals residing or expecting to reside for 90 days or longer in a long-term care facility).
Is there any coverage for dentures.
This plan offers limited dental services. Check with Humana to see.
My doctor may want me to have a special MRI that is not available in my network. Will I be charged out of network prices?
Please Check with Humana
I am on Humana Gold Plus HMO Wellmed Pflugerville, Tx. I need to know if I can make an appointment to go to Spicewood Phychotherapy Group?
Specialist for $45.00 and if I need to have a referral from my primary doctor. Where I can find a list of doctors that take this plan? Please email me the answer, Thank you
You can find Humana Doctors at Humana’s Website:
https://www.humana.com/finder/medical/
I don’t see any listed coverage for surgery: would a hip replacement be covered? What about General Surgery, like Cholecystectomy, Lumbar Laminectomy?
Does Humana Gold Plus HMO plans require authorization and/or referral for a doctors visit?
You would need to choose a primary care doctor. In most cases, you need a referral for specialists.