|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!
If you enroll in the Humana Gold Plus H1036-217 plan you will continue to pay your Medicare Part B premium. However, there's no additional monthly premium to be in this plan. Be aware that some people pay a higher Part B premium due to their annual income level (over $85,000 per year for singles or $170,000 for married couples) or due to a late enrollment penalty.
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
All 2017 Medicare Advantage plans have a $6,700 maximum out-of-pocket (MOOP) limit. That said, Medicare allows for a voluntary MOOP as low as $3,400.This plan's MOOP is $6,700. This figure is not inclusive of your monthly premium or the cost of your prescriptions (Medicare Part D Coverage).
This means that you will no longer pay copayment or coinsurance as soon as your copayments and coinsurance for doctor visits and hospital care reaches $6,700. This is your guarantee that an illness or accident will send you into bankruptcy. Consider the MOOP along with the premium and the copay.
If you're comparing this plan with Original Medicare, don't forget that you pay about 20% of all covered expenses, but there's no limit. You have a lot of risk with Original Medicare unless you buy a Medicare Supplement to cover your copayments and coinsurances.
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:
|Primary Care Doctor:||20% co-insurance|
|Physician Specialist:||$35 co-payment|
|Occupational Therapist:||$35 to $40 co-payment|
|Physical Therapist:||$35 to $40 co-payment|
|Speech Terapist:||$35 to $40 co-payment|
Medicare covers a wide range of preventive care services, including cardiovascular screenings, alcohol misuse screening and counseling, depression screen, and diabetes screening, to name just a few. Here's how this plan covers the following at no cost:
- 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
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
- 'Welcome to Medicare' preventive visit
- Yearly 'Wellness' visit
Urgent Care and Emergency Room
Urgent care and emergency room services are covered under Medicare Part B and have copayment or coinsurance fees. Some Medicare Advantage plans waive these fees if you are admitted as an inpatient within a specified number of days.
|Urgent Care:||$0 to $35 co-payment|
|Emergency Care:||$75 co-payment |
Co-insurance waived if admitted within 24 Hours
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:
- Day 1 to 7 you pay $275 per day
- See the Summary of Benefits for additional copayment periods.
Prescription Drug Coverage
Humana Gold Plus H1036-217 includes Medicare Part D coverage for your prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy at each tier level.
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The annual Part D deductible 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 Premier Plan
- Freedom Medicare Plan Rx
- Freedom Savings Plan
- AARP MedicareComplete
- AARP MedicareComplete Choice
Humana Gold Plus H1036-217 Availability
Humana Gold Plus H1036-217 is available in Alva, Lehigh Acres, North Fort Myers, Saint James City, Bokeelia, Fort Myers Beach, Estero, Sanibel, Pineland, Bonita Springs, Boca Grande, Cape Coral, Fort Myers, Captiva, and all other areas of Lee County.
This page was last updated on 10/25/2016.