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. |
So do I need a referral for Chiropractic if I go to an in network provider? Does my provider need to get pre- authorization for my care?
No Pre-authorization or referral is required for chiropractic services in-network.
Understand that Humana Gold follows Medicare guidelines:
The benefit is the initial (new patient) examination and spinal adjustment or manipulation (not joints of the upper or lower extremities).
Other services are NOT covered (ie. Follow-up examinations of an established patient; therapies; massage; acupuncture; etc).
Plus, all care must be deemed “medically necessary.” Such that there is a reasonable expectation of a “Significant Functional Improvement” in a short period of time. Thus, care may not be covered for “pain” or maintenance/preventative treatment. Generally, if one is treating with a chiropractor once every week or longer, that may be deemed non-therapeutic and not a covered benefit.
My mother and father have the Humana Plus Gold Plan. My father has dementia and my mother has a terminal brain tumor. They are having difficulties living by themselves and need assistance with medication reminder, household details, meals and they have both fallen in the last month. Does Humana cover any in home care?
Looking for provider for contact lenses in West Palm Beach, have Humana Gold Plus.
They don’t cover contact lenses.
A little over a year ago I was diagnosed with a cataract. It has grown to where my right eye is so blurry that I have trouble seeing out of it. Some things I can’t see at all. Do I need a referral to go to an ophthalmologist t have it removed. I’m 70 years old and have Humana Advantage Gold.
Yes you need a referral from your primary care physician to see a cataract surgeon.
Humana Gold Plus for Seniors is total CRAP!! You can’t get them to mail the medications even when the doctor’s office proves it has been submitted to them. My grandma is 90 years old and they would rather let her die than give her the prescribed blood pressure medications. When you speak to their “customer service” they act like you need to call the doctor’s office because the doctor “didn’t send it.” I sat next to the doctor’s nurse while she proved to them she had sent it with an electronic code number. Two weeks later and her medications STILL HAVE NOT come! Humana Gold Plus for Seniors is a disgrace!!!!!
I’m with you C Hurst… Humana Gold is crap!! Can’t get an answer on the phone for 2 days. Been on the website searching also for 2 days! I had questions for vision and she connects me to Dental??? SOOOOO FRUSTRATING! Should have stayed with United Healthcare 🙁
Which lens will Humana pay for if I’m having Cataract surgery ?
They pay for a standard non-toric monofocal lens. I got those for my cataract surgery and basically never need glasses now, so even though they’ll say you will definitely need glasses with monofocal IOLs, you might not need them at all or very little.
Hello
My father German has Humana Gold I called the dental benefits department and was provided the name of a participating dentist
when I look up the benefit information this is what is shows;
$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.
I got a call asking me to pay a dollar amount for a visit and the x-rays they performed on my dad. why? If $0 copay for up to 1 dental x-ray(s). they could not perform any cleaning or anything. my father will have to see a dental surgeon that can put him to sleep to remove 3 teeth.
can this be explained to me please.
thank you,
Maria
What about senior living facilities? Anything covered there with this plan?
Medicare and Medicare Advantage Plans never pay for senior living facilities. Only Medicaid pays (for certain nursing homes) if the person is eligible for Medicaid.
I just had an MRI and MRA here in SC I have a Humana Gold Plus HMO When I lived in NY when I had these tests it was just a small copay thru medicare Here in SC I just had these tests and it cost me $360.00
My mother has Humana Gold Plus and is almost 81 years old. I would like to know how to go about searching for a social worker while she is at her home residence. Any information would be greatly appreciated.
This is all new to me. I am her youngest daughter who lives nearby.
Either sign up for an online Humana account and look it up on their website or call their customer service (the phone number is on the back of the card) and ask the for some names and information.
what coverage is there for rehab equiptment after knee replacement like walkers etc
Does Humana gold plus cover counseling services?
I would like to know overall customer reviews of Humana GoldPLus HMO
I just received my ID cards, but I was under the impression
that my insurance was cancelled. I don”t understand this.
I have Humana Gold Plus HMO, what tier is Chantix and what will be my costs