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, $25 copay for the cost for Medicare-covered partial hospitalization program services. |
Will my Humana gold plus cover a portable oxygen machine for me?
I have tried several web sites for a URO-GYN and nothing comes up in my area of Plantation FLA. I have been on Humana Gold Plus for several years. Also I think the referral rule is stupid. You never can get the referrals to be there at the Appt time. They Should drop referrals like most other insurance did. The DRS Humans have been low grade DRS. When will they upscale their DRS?
Why am i paying copay primary doctor if it states. O copay and x-rays and. RMI 100$
Humana gold hmo
It can be difficult enough to manage old age but when you go to a doctor you have used before and suddenly you realize you have to have a referral & authorization and you have to turn around and go back home without the injection in my knees to keep me able to walk it is heartbreaking….is it necessary when you have the member card and are a member and the doctor is certified, etc, etc? Why all that extra…I was thrilled with the Golden plus…..and now I feel disappointed..I could have gone with a ppo but was told this is the best…..some easier quicker way has to be implemented ….I fear the doctors will stop accepting it if they also have to jump through hoops as we do…..can it be simple as many policies are with other companies. ?????Please look at these rules again and simplify if possible! Thank you!
My Mom needs to stay at SNF because she fractured her left shoulder. She is left handed person and her baseline is using a two-handed walker to get around. Since the fracture she is unable to use the two-handed walker. The stupid hospital released my Mom to our homes (Brother and I using Kindred, but they did provide a way for my Mom to be transported. Kindred did not work because our homes are not equipped with rehabilitation equipment. My Mom at O.T. and P.T. help 3 times a week, but only using her right arm to get around from transport chair (I had to buy) and to the bed and bathroom. She was not able to use the bathroom by herself, my Husband had to left her up and I can pull her pants down and we sit her down. It was just too much, putting my Mom in unsafe conditions. My Mom almost fell twice at our home. Not good. So I admitted her to SNF in Contra Costa County affiliated with IPA Sutter Health Care Center. Just the second week the IPA Sutter Case manager wanted to deny my Mom coverage which in the details sounded like this person does not know anything about REHAB for NWB and how a person progresses. My Mom was not ready to leave on her own and back to our homes. My Mom pays for the Humana Gold plus and they have coverage for 100 days and with co-pay. So I fought and Humana Appeals says my Mom has always been approved and they never got the deny of coverage. Then after I fought if for weeks and my Mom needed another re-authorization, they denied my Mom again using the same words in the details. I called this person up and she told me they have a criteria, which I never heard such a thing, there are no requirements mentioned in the Humana 2019 Gold Plus Advantage plan whatsoever. First Deny – they said my Mom did not participate 100% and the second time same words and now says Mom has not participated and then that she can use one-arm walker now and reason they deny again. According to Humana Appeals Medical Professionals they say my Mom needs to stay there, along with the Doctor’s Recommendation. It seems these people sit in offices miles away and they make decisions to deny my Mom coverage. I was so upset and right now I do not know what to do and why these people get away with it. What is it to them to just approve my Mom — my Mom has improved 80% since her stay there. My Mom is 89 years old, blind in her left eye, bad arthritis in her right knee she broke he left hip in 2014, her memory is going and she is incontinent the wording just because she guards her shoulder is a bad thing and reason to disqualify. Same words as a month ago. My Mom is required to be strong enough in her right arm in a week – when does it say an Insurance has these requirements for elderly person to stay and get rehab while recovering from a injury!! This is outrageous. The approval is done weekly and just because a new authorization was set for 02/18/2019 already the SNF and Sutter Case Manager already planned for my Mom’s discharge. But again, Humana never gets the deny letter and they still pay. I believe there is some sort of scam going on between Diamond Ridge in Pittsburg and Sutter Health center. They deny and patients stay and get charged twice. Plus they have no right to deny my Mom for any reason. I have about had it- law abiding citizens gets treated like this while illegal aliens are getting far more money per month and free medical care under MEDICAD!!
Will my Humana Medicare Gold HMO plan pay for medical expenses related to TMJ treatment?
I want to express my thoughts on the current Phillips life Line unit. Because I have other things that use the telephone, I am not able to use not because this unit has to be the first. I much rather have the PERS unit we had before. It did not use my phone line and was a free-standing unit. Please consider going back to the PERS unit.
My mother was told by her doctor that under her HMO she must see the doctor every month whether she wants to or not. Is this a requirement of you manacle plus that they must see their doctor every month even if they feel fine. Her doctor said if she doesn’t get seen every month he won’t be able to be her doctor anymore.
I have Humana Gold and when I go to the dentist I am charged $20 for cleaning and xrays? Am I suppose to be charged a copay?
Have Humana gold plus, can not find anything whether the Shingrix shots are covered.
Thank you
In Preferred Brand medications, what if $2930.00 does not cover a year’s supply? What does it cost me for the years not covered? Reference Toujeo.
does Humana Gold cover aquatic exercise programs at wellness center
My daughter has Humana Gold Plus and cant find a primary Dr that will except this Ins .In st petersburg FL or Pinellas Park FL . Can you help ? thank you
I’m looking for a urology clinic near me,at the present time I residing we my son at Smith Station Alabama,36877 and I come up we a (UTI)the doctor recommend for me to see specially need a list of Humana plus urology clinic
I am looking at Humana Gold Advantage plan but am concerned if it will pay for services if I am out of town or state> I go out of state periodically and dont want to get a surprise when I do and find out that it is no good there. One visit would be to a state that does not have Advantage Plans.