Humana Gold Plus H1036-217 Lee County, Florida 2017 Medicare Advantage Plan H1036-217

HMO Plan
5-Star Rating:{plan}, a Medicare Advantage plan available in Lee County, FL, an average Medicare rating of 4.0 out of 5 stars.
Plan ID:H1036-217
Plan Year:2017
Full Premium:$0.00/mo
Annual MOOP:$6,700
Part D Benefit:Yes
Rx Deductible:$0.00/year
Rx Gap Coverage:Yes
Online Pharmacy:No
Plan Phone #:888-204-4062
Summary of Benefits: Humana Gold Plus H1036-217 Medicare Advantage Plan H1036-217 Summary of Benefits for Lee County, Florida

Humana Gold Plus H1036-217 Medicare Advantage Plan for Lee County, Florida seniors on Medicare.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.

Monthly Premium

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.

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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.

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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.

Doctor Visits

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
Chiropractor:$20 co-payment
Occupational Therapist:$35 to $40 co-payment
Physical Therapist:$35 to $40 co-payment
Speech Terapist:$35 to $40 co-payment
Psychotherapist:$35 co-payment
Psychiatrist:$35 co-payment
Podiatrist:$35 co-payment

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Preventive Care

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

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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
Worldwide Coverage:Yes
Ambulance:$250 co-payment

Hospital Stays

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.
The hospital benefit period is No Hospital Benefit Period.

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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.

TierDrug ClassCopay
1Preferred Generic$0
3Preferred Brand$45
4Non-Preferred Brand$95
5Specialty Tier33%

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).

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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 Plans

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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.

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This page was last updated on 10/25/2016.