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 have called Humana multiple times in an attempt to get a list of dental providers included in the new dental benefit (basic dental – check up, cleanings, etc) for Humana Gold Plus H2012-037 for 2017. I am trying to decide between two medicare advantage plans. I have NEVER been able to access that information from Humana and am extremely frustrated. Where is the list of providers for this particular dental plan (part of medical; not a special add-on). I am in the Seattle area. Zip 98026
Hi Mark,
I am in Virgina…23663….and had my 2nd cataract surgery in July, 2016. NO WHERE can I find a provider…even the doc that performed the surgery…. that will file my H-HMO for the $0 copay prescription glasses post cataract…..NO WHERE. They say they do not get paid…it is a shame that the benefit is unable to be used….most seniors will need it at some point. For glasses I am going to have to pay out of pocket….or just use EyeMed. What are your thoughts on this? Thx so much!
I have Humana Gold Plus HMO plan H2649-062. When I checked my plan benefit booklet on page 78 it says $0 copay meet for people with diabetes, age 50 or over.
good day, i am from hospital here in Phillipines, we have patient here, US citizen form chicago, and presently confine here, he has a a Humana Gold Plus (HMO)card. Question, can he avail his insurance and pay his hospital bill? What is the process?
Thanks
My David Foster Jr I had a bad motorcycle accident in 2001. And Humana Gold Plus HMO was the best. I almost lost my leg I had 63 fractures and two compound breaks and a crack in my disc in my back. I have been on OxyContin 80 mg 4 day for years I am 45 years old. And now the changed there plan Covage. I take it to get around with way of life is not great but it’s better when I take my meds. I just don’t see how you can cut me off. I have tryed everything out there and that what works best for by body and pain every day of my life is not fun with a 10 year old son . My other 2 son have graduated from one of the best school money could pay archbishop Shaw High school. In 2010 and 2015. And I adopted both of them now you tell me this today. I hope your review board ok my meds to get filled because I really need them if not I have to find another insurance company that will.
I just spoke to a CSR from Humana. I have Humana Gold Plus. I have been referred to a Bariatric Surgeon by my Humana PCP with a BMI of 54. The lady on the phone told me that Bariatric surgery is not covered with my policy. I find this hard to believe.
Need to have dental group in coverage. I have no cards or anything do have I’d coverage #.
If I have cataract surgery at end of year under one insurance plan and then first of year enroll in Humana plan, who is responsible for covering the post cataract eyeglasses?
For Humana Gold Plus for Seniors what would a copay be for an MRI?
IS REFERRAL A MUST FROM PCP FOR THE PATIENT’S POLICY HUMANA GOLD PLUS
Is this the plan with a 4.5 Star Rating, according to CMS standards?
Does Humana Gold Plus provide transportation assistance from Home to doctor’s appts. and back home?
Would my HUMANA GOLD PLUS HMO cover Psychology COUNSELING
for high anxiety and depression?
I have had my eye exam by Humana covered Discover, in Kansas City, Ks. I am now waiting for pre-op exam to schedule cataract surgery. I need to know what my charges will be for the surgery. I know the exam, and I can find info on one pair of glasses, but nothing on the amount I will be paying for the surgery, I have Humana Gold and Medicare
Hello,I have been going to see my shoulder doctor,and I had an appointment to speak with a specialist to do surgery, but that call me and informed me that they no longer accept Humana Gold Plus(HMO SNP),now what do I do,and where do I find a doctor that accept it?