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 am under going radiation treatment for prostate cancer for the last
month, today I received a bill for co-pay for 30 dollars a treatment,
for a total for 45 treatment for a grand total of 1,350.00. When i
started the treatment nothing was said about a co-pay. Friends I know
had the same treatment last year a paid nothing. 1350.00 dollars is
a lot of money, and for many people who can not afford that kind of bill.
When did Humana start this process.
Please Check with Humana to clear this up.
Just received a bill from Piedmont Healthcare in the amount of $103.55. This represents a co-pay for a head CT on 2/8/2016. I have extra help and it was my understanding that this bill would be covered 100%. Is there something I need to do? Thank you. Jan
Please Check with Humana
My dad had a heart attack in January. He has Humana Gold Plus. He is now being told that he is in the “donut hole” for his prescriptions due to the hospital visit. Should the medicines received during this visit go toward medical insurance not pharmacy?
This can get confusing please see this publication:
https://www.medicare.gov/pubs/pdf/11333.pdf
Hope this helps
I have a cataract that needs to be removed. I am covered by Humana Gold Plus HMO. Is there any financial coverage from this plan?
Please see:
https://www.medicare.gov/coverage/cataract-surgery.html
I need a list of mental health providers that has this ins coverage
Sign in to MyHumana (https://www.humana.com/logon)
Do you cover any type of lap ban surgery?
Medicare may cover please see:
https://www.medicare.gov/coverage/bariatric-surgery.html
I have Humana Gold Plus HMO. I am searching for a provider for Diabetic shoes and a back brace. My zip is 19020 Can anyone help ?
You can find providers here:
https://www.humana.com/finder/medical/
How much is 30 day supply Lyrica?
http://www.medicarehelp.org/2016-formularies/Lyrica
I need an ophthalmologiiist in or near 19136 zip code can you please help
Sign in to MyHumana (https://www.humana.com/logon)
I have humana gold plus am I covered for dental extractions, if not how do I get dental coverage that covers extractions?
Humana Gold Plus offers Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth). Please Contact Humana directly to verify this.
I have Humana Gold Plus HMO and was wondering what health clubs it covers such as YMCA, etc? Thanks you.
Humana offers a SilverSneakers program you can learn more here:
https://www.silversneakers.com/
Is lasik eye surgery for astigmatism covered by Humana Gold Plus Snp plan, plus North Carolina Medicaid as secondary?
Most insurance companies don’t cover LASIK, because laser eye surgery is nearly always considered an elective or cosmetic surgery.
My mother needs cateract surgery with Gold coverage. What do you and Medicare cover? The surgeon has qouted her from $3250 per eye to $1550 per eye. But my best friend just had the same surgery and only paid $35.00, she had Attneda, plan G and Medicare.
Mom’s sugeon wants her to pay the entire amount before he will perform the surgery
Medicare offers additional coverage for cataract surgery so Humana must provide the same coverage. Please Check.
https://www.medicare.gov/coverage/cataract-surgery.html
Where can I find information about Humana Gold Plus medical coverage outside the USA. What medical and medical emergency is covered? Is there a yearly or lifetime maximum coverage for such service? Is there a maximum of time one can be outside of the USA for coverage to still be available? Where can I find this information in the Humana policy
Is there a booklet with Dr. names, specialties, etc. for my area 60061?
Also need dentist for the same. Thank you
Where would I get this?
You can find providers here:
https://www.humana.com/finder/medical/