|Part D Benefit:||Yes|
|Rx Gap Coverage:||Yes|
|Plan Phone #:||888-204-4062|
|Summary of Benefits:|
Humana Gold Plus H1036-217 is a Health Maintenance Organization (HMO) Medicare Advantage plan, by Humana Medical Plan, Inc., available in Lee County, Florida. It offers all of the basic benefits of Original Medicare and may include additional coverage.
With an HMO plan, like this one from Humana Medical Plan, Inc., your out-of-pocket costs are much lower than Original Medicare. That's the big advantage.
IMPORTANT: You must use providers in the Humana Medical Plan, Inc. network to avoid incurring additional costs. You are responsible for all costs incurred out of network. Referrals are generally required to see specialists.
This plan has a zero dollar premium!
This plan does not charge an additional monthly premium. The full cost is covered by your Medicare Part B premium. If you don't have a late enrollment penalty and your annual income is less than $85k ($170k for married couples) you'll pay the standard Medicare Part B premium.
IMPORTANT NOTICE: Double-digit price hikes for Medicare Part B premiums are coming in 2016. The base tier premium is expected to jump from $104.90 to $120.70.
In addition to the premiums you also pay your share when you use healthcare services. Each time you see your doctor, or if you are admitted as an inpatient (hospitalized), you'll pay copayments. Your prescription drugs also have a cost sharing component.
Maximum Out-of-Pocket Limit
There is a maximum out of pocket limit of $6,700 on your healthcare costs in 2016. This is commonly called the plan MOOP. The MOOP does not include your prescriptions or your monthly premium.
Although the mandatory MOOP limit is $6,700, Medicare allows for a lower “Voluntary MOOP” that can be as low as $3,400. This plan's MOOP is $6,700. Take this figure into as much consideration along with the premium and the copay.
If you are comparing this plan with Original Medicare, factor in that there are no out-of-pocket limits on Medicare Parts A and B. With Original Medicare you'll need a Medicare Supplement to cover what the government doesn't.
Coverage, Copayments & Coinsurance
The Humana Gold Plus H1036-217 plan offers the same basic benefits as Original Medicare. The big difference is copayments and coinsurances. Below you will find (where available) what you will pay for common health care services.
Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:
- Acupuncture and Other Alternative Therapies
- Not covered
- Ambulance Services
- $150 copay
- Chiropractic Care
- Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): $20 copay
- Dental Services
- Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth): $35 copay
- Diabetes Supplies and Services
- Diabetes monitoring supplies: 0-20% of the cost depending on the supply
- Diabetes self-management training: No cost to you
- Therapeutic shoes or inserts: No cost to you
- Diagnostic Tests, Lab and Radiology Services, and X-Rays
- Diagnostic radiology services (such as MRIs CT scans): $50-150 co-pay depending on the service
- Diagnostic tests and procedures: $0-150 co-pay depending on the service
- Lab services: $0-150 co-pay depending on the service
- Outpatient x-rays: $0-150 co-pay depending on the service
- Therapeutic radiology services (such as radiation treatment for cancer): $25-35 co-pay or 20% of the cost depending on the service
- Doctor's Office Visits
- Primary care physician visit: No cost to you
- Specialist visit: $35 copay
- Durable Medical Equipment (wheelchairs, oxygen, etc.)
- 0-20% of the cost depending on the equipment
- If you go to a preferred vendor your cost may be less. Contact us for a list of preferred vendors.
- Emergency Care
- $65 copay
- If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for emergency care. See the Inpatient Hospital Care section for other costs.
- Foot Care (podiatry services)
- Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: $35 copay
- Hearing Services
- Exam to diagnose and treat hearing and balance issues: $35 copay
- Routine hearing exam (for up to 1 every year): No cost to you
- Hearing aid fitting/evaluation (for up to 1 every year): No cost to you
- Hearing aid: No cost to you
- Humana Gold Plus H1036-217 pays up to $1,000 every year for hearing aids.
- Home Health Care
- No cost to you
- Mental Health Care
- Inpatient visit:
- Humana Gold Plus H1036-217 covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital.
- Humana Gold Plus H1036-217 covers 90 days for an inpatient hospital stay.
- Humana Gold Plus H1036-217 also covers 60 lifetime reserve days. These are extra days Humana Gold Plus H1036-217 covers. If you are an inpatient for more than 90 days you can use these extra days. But once you have used up these extra 60 days your inpatient hospital coverage will be limited to 90 days.
- $218 co-pay per day for days 1 through 7.
- No cost to you per day for days 8 through 90.
- Outpatient group therapy visit: $35 copay
- Outpatient individual therapy visit: $35 copay
- Outpatient Rehabilitation Services
- Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks): $35-150 co-pay depending on the service
- Occupational therapy visit: $35-40 co-pay depending on the service
- Physical therapy and speech and language therapy visit: $35-40 co-pay depending on the service
- Outpatient Substance Abuse
- Group therapy visit: $150 copay
- Individual therapy visit: $150 copay
- Outpatient Surgery
- Ambulatory surgical center: $50 copay
- Outpatient hospital: $40-150 co-pay or 20% of the cost depending on the service
- Over-the-Counter Items
- Visit the plan's website to see their list of covered over-the-counter items.
- Prosthetic Devices (braces, artificial limbs, etc.)
- Prosthetic devices: No cost to you
- Related medical supplies: No cost to you
- Renal Dialysis
- 0-20% of the cost depending on the service
- Not covered
- Urgently Needed Care
- $0-35 co-pay depending on the service
- Vision Services
- Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): $0-35 co-pay depending on the service
- Routine eye exam (for up to 1 every year): No cost to you
- Contact lenses (for up to 1 every year): No cost to you
- Eyeglasses (frames and lenses) (for up to 1 every year): No cost to you
- Eyeglasses or contact lenses after cataract surgery: No cost to you
- Humana Gold Plus H1036-217 pays up to $150 every year for contact lenses and eyeglasses (frames and lenses).
If you are admitted to a hospital or clinic for treatment and stay overnight, you are an inpatient. Most plans have tiered costs for inpatient treatment. Here's how this plan covers you:
- Humana Gold Plus H1036-217 covers an unlimited number of days for an inpatient hospital stay.
- $250 co-payment per day for days 1 through 7.
- You pay nothing per day for days 8 through 90.
- You pay nothing per day for days 91 and beyond.
- Humana Gold Plus H1036-217 covers up to 100 days in a Skilled Nursing Facility (SNF).
- $0 co-payment per day for days 1 through 20.
- $150 co-payment per day for days 21 through 100.
Medicare covers some preventive care services, including cardiovascular screenings, alcohol misuse screening and counseling, depression screen, and diabetes screening. This plan covers preventive services as follows:
- Preventive Care
- You pay nothing
- Humana Gold Plus H1036-217 covers many preventive services including:
- Abdominal aortic aneurysm screening.
- Alcohol misuse counseling.
- Bone mass measurement.
- Breast cancer screening (mammogram).
- Cardiovascular disease (behavioral therapy).
- Cardiovascular screenings.
- Cervical and vaginal cancer screening.
- Colorectal cancer screenings.
- Depression screening.
- Diabetes screenings.
- Fecal occult blood test.
- Flexible sigmoidoscopy.
- HIV screening.
- Medical nutrition therapy services.
- Obesity screening and counseling.
- Prostate cancer screenings (PSA).
- Sexually transmitted infections screening and counseling.
- Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease) .
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots.
- Welcome to Medicare preventive visit (one-time checkup).
- Yearly Wellness visit.
- All other preventive healthcare services approved by Medicare during the contract year will be covered.
Prescription Drug Coverage
This plan includes Medicare Part D coverage for your prescription medications. The formulary (00015093) has a total of 3,617 prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.
|Formulary Drug Details:||Tier 1||Tier 2||Tier 3||Tier 4||Tier 5|
|— Drugs per Tier:||392||827||788||1195||415|
|— Cost-Sharing in ICP:||$0.00||$20.00||$45.00||$95.00||33%|
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The Part D deductible on this plan is $0.00 (first dollar coverage).
Medicare Plan Rating
Medicare gave the Humana Gold Plus H1036-217 plan an average rating of 4.0 out of 5 stars. This rating is Above Average, by Medicare's definition.
Medicare evaluates the quality of all Medicare Advantage plans. Plans are rated using a one to five-star scale, with five stars being the highest quality. If a plan is rated less than 2.5 stars, Medicare will not allow new members to enroll.
Compare Humana Gold Plus H1036-217 with these top rated plans available in Lee County:
- Aetna Medicare Connect Plus
- Aetna Medicare Connect Plus
- Freedom Medicare Plan Rx
- Freedom Savings Plan
- Humana Gold Choice H8145-061
Humana Gold Plus H1036-217 Availability
Humana Gold Plus H1036-217 is available in Fort Myers, Sanibel, Bonita Springs, Bokeelia, Alva, Saint James City, Estero, Captiva, Cape Coral, North Fort Myers, Boca Grande, Pineland, Fort Myers Beach, Lehigh Acres, and all other areas of Lee County.
This page was last updated on 10/12/2015.