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 Humana Gold Plus HMO and how much would I have to pay for cataract surgery?
I have humana gold plus hmo and how much would I have to pay for cataract surgery
Is the big difference between hmo&ppo-u need refferslls for him. Can u send me chart w/the differences between the 2 please?
I have Humana PPO what is the difference between PPO &
HMO
I have humans gold plus HMO. I need to see a dentist for a loose
Crown. Who would I see for treatment
Okay thank you.
How much was it
Does my Humana Gold Plus insurance pay for dentures.
I have Humana Gold Plus HMO, but it’s h10 36 – 199 I don’t see the benefits here. For that plan.
Does humana gold plus cover de tal bridges ?
How many root canals allowed in one year ?
Do you have s plan that covers implants ?
What is the cost of radiation therapy for breast cancer
Does Humana Gold pay for a family member to stay home and care for an elderly parent?
My husband is in a group plan from his retirement for Humana Gold. He is now practically bed ridden. No independent mobility at all. Does Humana Gold cover home health care? He needs assistance to go to the restroom & shower. He also needs assistance dressing.
I have Humana Gold Plus Advantage. How much will Humana pay towards a non surgical tooth extraction.
I have been diagnosed with breast cancer and will require radiation therapy. The therapy will begin with a visit to the Oncologist every day for five days and will last between seven to ten weeks.
What portion of these treatments would I have to pay?
DO I have a plan D with my policy? H49958729
What does advantage hmo plus gold pay for knee replacement?
I have Humana GoldPlus, do I need a referral for pain management?
So I have Humana Gold Choice with partial network coverage. One what exactly does that mean? I also have a Medicare card that’s says plan A and B. Does this cover long term care if I were to enter a nursing home?
What about Silver Sneaker program and travel to and from dental and doctors appointment if a spouse is working or can’t drive due to their illness
Dental for 2020
u are out of luck, no teeth for you.
I have Medicaid, and Humana Gold Plus HMO D-SNP, I guess that tells you I have Medicaid, Medicare part a, b, c, d and extra help…. I have everything. I don’t pay my spindown because I can’t afford to. My question is: am I still qualified for the silver sneakers program? I know I could call the gym, but I came across this discussion.
Thanks
I have Humana GoldPlus, do I have to pay the 20% coinsurance that Medacare does not pay of dialysis or does Humana pay this 20%?
I take APAP/CODEINE TAB 300-60MG 2 daily. What will I pay for the same with Humana Gold Plus Plan for a month?
does humana gold cover silver sneakers for 2020
i have Humana gold– does that include silver seekers gym as well ??? Note:: if not– it says that Humana does not give a crap about me and other older people–who have paid for many-many-many years of insurance !!!
A recent visit to eye doctor I had to pay the $35 co pay but was also charged for refraction. I don’t recall having to pay for refraction previously.
I have Humana Gold Plus (HMO). How much does this insurance pay for prescription eye glasses?
I need Dentures How much will it cover to get them
I have Humana Gold Plus HMO H2266-037. Does it cover dentures.
How does Humana gold plus coordinate with champva?
Which plan in 33412 zrp code returns the $135 monthly social security amount? How is that amount returned to beneficiary?
I have Humana gold plus advantage plan. I have been trying to get a new rollator walker. It is an approved item for durable medical equipment. However I have been unable to get assistance from Humana as to where I can purchase. I receive a list of approximately 100 vendors. In which includes all DME. I have spent over 80 hours on the phone trying to sort out a reliable vendor. Humana says they don’t have the time to give me only ones which would serve my purpose. Anything I can do? Who can I visit with outside of Humana. Or even Humana representative that will assist me. This has been over a year in progress or lack of progress. My Dr has filled out unneeded paperwork, prescriptions until they are worn out. Who can help me?
Does Humana gold plus cove pcd treatment for skin cancer