CHCBP is a premium-based plan that offers temporary transitional health coverage for 18 to 36 months after TRICARE eligibility ends. It acts as a bridge between military health benefits and your new civilian health plan. HumanaChoice Florida H5216-072 (PPO) has a monthly drug premium of $0 and a $150.0 drug deductible. This Humana plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits.
Jump to:
Humana Gold Plus H4461-036 (HMO-POS) H4461-036 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Humana available to residents in Tennessee. This plan includes additional Medicare prescription drug (Part-D) coverage. The Humana Gold Plus H4461-036 (HMO-POS) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $5,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,900 out of pocket. This can be a extremely nice safety net.
Humana Gold Plus H4461-036 (HMO-POS) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Gold Plus H4461-036 (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST
2021 Humana Medicare Advantage Plan Costs
| Name: | |
|---|---|
| Plan ID: | H4461-036 |
| Provider: | Humana |
| Year: | 2021 |
| Type: | Local HMO |
| Monthly Premium C+D: | $0 |
| Part C Premium: | $0 |
| MOOP: | $5,900 |
| Part D (Drug) Premium: | $0 |
| Part D Supplemental Premium | $0 |
| Total Part D Premium: | $0 |
| Drug Deductible: | $0 |
| Tiers with No Deductible: | 0 |
| Gap Coverage: | No |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Similar Plan: | H4461-037 |
Humana Gold Plus H4461-036 (HMO-POS) Part-C Premium
Humana plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H4461-036 Part-D Deductible and Premium
Humana Gold Plus H4461-036 (HMO-POS) has a monthly drug premium of $0 and a $0 drug deductible. This Humana plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Humana above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Humana Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Humana plan does not offer additional coverage through the gap.
H4461-036 Formulary or Drug Coverage
Humana Gold Plus H4461-036 (HMO-POS) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 Humana Gold Plus H4461-036 (HMO-POS) Summary of Benefits
Additional Benefits
Humana Copay Plans Medicare
| No |
|---|
Comprehensive Dental
| Diagnostic services | Not covered |
|---|---|
| Endodontics | Not covered |
| Extractions | 55% coinsurance (Out-of-Network) |
| Extractions | 0% coinsurance |
| Non-routine services | Not covered |
| Periodontics | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
| Restorative services | 55% coinsurance (Out-of-Network) |
| Restorative services | 0% coinsurance |
Deductible
| $0 |
|---|
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $35-295 copay |
|---|---|
| Diagnostic tests and procedures | $0-100 copay |
| Lab services | $0-35 copay |
| Outpatient x-rays | $0-35 copay |
Doctor Visits
| Primary | $0 copay |
|---|---|
| Specialist | $35 copay per visit |
Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
|---|---|
| Urgent care | $0-35 copay per visit (always covered) |
Foot Care (podiatry services)
| Foot exams and treatment | $35 copay |
|---|---|
| Routine foot care | Not covered |
Ground Ambulance
| $290 copay |
|---|
Humana Copay Plans Online
Hearing
| Fitting/evaluation | $0 copay |
|---|---|
| Hearing aids | $399-699 copay |
| Hearing exam | $35 copay |
Inpatient Hospital Coverage
| Not Applicable (Out-of-Network) |
|---|
| $295 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 91 and beyond |
Medical Equipment/Supplies
| Diabetes supplies | $0 copay or 10-20% coinsurance per item |
|---|---|
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
|---|---|
| Other Part B drugs | 20% coinsurance |
Mental Health Services
| Inpatient hospital - psychiatric | Not Applicable (Out-of-Network) |
|---|---|
| Inpatient hospital - psychiatric | $295 per day for days 1 through 6 $0 per day for days 7 through 90 |
| Outpatient group therapy visit | $35 copay |
| Outpatient group therapy visit with a psychiatrist | $35 copay |
| Outpatient individual therapy visit | $35 copay |
| Outpatient individual therapy visit with a psychiatrist | $35 copay |
MOOP
| $5,900 In-network |
|---|
Option
| No |
|---|
Optional supplemental benefits
| No |
|---|
Outpatient Hospital Coverage
| $35-295 copay per visit |
|---|
Preventive Care
| $0 copay |
|---|
Preventive Dental
| Cleaning | $0 copay |
|---|---|
| Cleaning | $0 copay (Out-of-Network) |
| Dental x-ray(s) | $0 copay |
| Dental x-ray(s) | $0 copay (Out-of-Network) |
| Fluoride treatment | Not covered |
| Oral exam | $0 copay (Out-of-Network) |
| Oral exam | $0 copay |
Rehabilitation Services
| Occupational therapy visit | $25 copay |
|---|---|
| Physical therapy and speech and language therapy visit | $25 copay |
Skilled Nursing Facility
| Not Applicable (Out-of-Network) |
|---|
| $0 per day for days 1 through 20 $184 per day for days 21 through 100 |
Transportation
| Not covered |
|---|
Vision
| Contact lenses | $0 copay |
|---|---|
| Eyeglass frames | Not covered |
| Eyeglass lenses | Not covered |
| Eyeglasses (frames and lenses) | $0 copay |
| Other | Not covered |
| Routine eye exam | $0 copay |
| Upgrades | Not covered |
Wellness Programs (e.g. fitness nursing hotline)
| Covered |
|---|
Reviews for Humana Gold Plus H4461-036 (HMO-POS) H4461
| 2019 Overall Rating |
|---|
| Part C Summary Rating |
| Part D Summary Rating |
| Staying Healthy: Screenings, Tests, Vaccines |
| Managing Chronic (Long Term) Conditions |
| Member Experience with Health Plan |
| Complaints and Changes in Plans Performance |
| Health Plan Customer Service |
| Drug Plan Customer Service |
| Complaints and Changes in the Drug Plan |
| Member Experience with the Drug Plan |
| Drug Safety and Accuracy of Drug Pricing |
Staying Healthy, Screening, Testing, & Vaccines
Humana Copay Plans List
| Total Preventative Rating |
|---|
| Breast Cancer Screening |
| Colorectal Cancer Screening |
| Annual Flu Vaccine |
| Improving Physical |
| Improving Mental Health |
| Monitoring Physical Activity |
| Adult BMI Assessment |
Managing Chronic And Long Term Care for Older Adults
| Total Rating |
|---|
| SNP Care Management |
| Medication Review |
| Functional Status Assessment |
| Pain Screening |
| Osteoporosis Management |
| Diabetes Care - Eye Exam |
| Diabetes Care - Kidney Disease |
| Diabetes Care - Blood Sugar |
| Rheumatoid Arthritis |
| Reducing Risk of Falling |
| Improving Bladder Control |
| Medication Reconciliation |
| Statin Therapy |
Member Experience with Health Plan
| Total Experience Rating |
|---|
| Getting Needed Care |
| Customer Service |
| Health Care Quality |
| Rating of Health Plan |
| Care Coordination |
Member Complaints and Changes in Humana Gold Plus H4461-036 (HMO-POS) Plans Performance
| Total Rating |
|---|
| Complaints about Health Plan |
| Members Leaving the Plan |
| Health Plan Quality Improvement |
| Timely Decisions About Appeals |
Health Plan Customer Service Rating for Humana Gold Plus H4461-036 (HMO-POS)
| Total Customer Service Rating |
|---|
| Reviewing Appeals Decisions |
| Call Center, TTY, Foreign Language |
Humana Gold Plus H4461-036 (HMO-POS) Drug Plan Customer Service Ratings
| Total Rating |
|---|
| Call Center, TTY, Foreign Language |
| Appeals Auto |
| Appeals Upheld |
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
|---|
| Complaints about the Drug Plan |
| Members Choosing to Leave the Plan |
| Drug Plan Quality Improvement |
Member Experience with the Drug Plan
| Total Rating |
|---|
| Rating of Drug Plan |
| Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
| Total Rating |
|---|
| MPF Price Accuracy |
| Drug Adherence for Diabetes Medications |
| Drug Adherence for Hypertension (RAS antagonists) |
| Drug Adherence for Cholesterol (Statins) |
| MTM Program Completion Rate for CMR |
| Statin with Diabetes |
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Humana Gold Plus H4461-036 (HMO-POS)
Humana Copay Plans Part
(Click county to compare all available Advantage plans)
| State: | Tennessee |
|---|---|
| County: | Bledsoe,Bradley,Franklin,Grundy,Hamilton, Marion,McMinn,Meigs,Polk, Rhea,Sequatchie, |
Go to top
Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
Last Updated : 10/21/20185 min read
Original Medicare, Part A and Part B, doesn’t generally cover routine vision services. If you have an injury or a medical condition that affects your eyes or vision, you may be covered for medically necessary care to diagnose and treat your condition, but routine vision exams are generally not covered. However, if your doctor considers you to be at risk for glaucoma, Medicare Part B may cover an annual glaucoma screening.
Find affordable Medicare plans in your area
If you are covered by a Medicare Advantage plan through Humana, you may be eligible for routine vision care benefits. Here are answers to your questions about Medicare vision coverage under Humana’s Medicare Advantage plans. Read here for general information on Medicare Advantage plans.
What is routine vision care?
It’s important to know what routine vision care might typically entail. This may include annual eye exams to check for vision impairment or underlying health issues, which may include the use of dilating eye drops to evaluate the lens, retina, and optic nerve, and a glaucoma screening test even if you’re not at risk for the disease. Other eye care services, such as fitting prescription eyewear or contact lenses to treat vision impairment, may also be considered routine vision care.
As mentioned above, Original Medicare doesn’t cover routine vision services, although Medicare Part B may cover an annual glaucoma screening if you’re at risk for the disease. Original Medicare may cover eye surgery, but coverage details are different depending on whether you’re admitted as an inpatient, or you have outpatient surgery. If you have cataract surgery and receive an intraocular lens, Medicare Part B usually covers one pair of corrective glasses or contact lenses.
What vision coverage is available with Medicare Advantage plans from Humana?
Medicare Advantage, Part C of the Medicare program, is administered by private companies like Humana that are contracted with Medicare to provide health-care benefits to enrollees. All Medicare Advantage plans must provide at least the same coverage as Original Medicare (except for hospice care, which is still provided under Part A), but companies are allowed to offer additional benefits with their Medicare plans.
Some of Humana’s Medicare Advantage plans give you an option for routine vision care in the form of a MyOptionSM Vision plan. The MyOptionSM Vision plan includes benefits such as
- A set dollar allowance to be used toward an annual eye exam at the provider of your choice. If you use Medicare providers in your Humana plan’s network, the allowance will cover the full cost of your routine eye exam.
- An annual allowance toward prescription eyeglasses and/or contact lenses.
Please note that you will be responsible for any costs above the plan-approved amount for your care and you must pay an additional monthly premium for your MyOptionSM vision plan. There is no special enrollment period; you may request MyOptionSM coverage at any time during the year.
Other things to keep in mind about Medicare Advantage plans offered by Humana:
- You must continue to pay your Part B premium plus any additional premium required by your plan.
- Not all plans may be available in all locations, and plan benefits and premiums may vary depending on where you live.
- Depending on the plan you choose, you may be required to get care from Humana’s network of Medicare providers in order to be covered (except in the case of medically necessary emergency treatment). Some plans also require copayments, coinsurance, and/or annual deductibles.
Do you have questions about Medicare plans offered by Humana? Humana makes it easy to learn about these plans. You can also simply click the “Find plans” link on this page.
Humana MyOptionSM optional supplemental benefits (OSB) are only available to members of certain Humana Medicare Advantage (MA) plans. Members of Humana plans that offer OSBs may enroll in OSBs throughout the year. Benefits may change on January 1st each year.
*Humana is a Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. [Benefits, premiums and/or member cost-share] may change on January 1 of each year. The [Formulary, pharmacy network, and/or provider network] may change at any time. You will receive notice when necessary.
**Out-of-network/non-contracted providers are under no obligation to treat <Plan/Part D Sponsor> members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
***Insured by Humana Insurance Company, The Dental Concern, Inc., Humana Insurance Company of New York, Humana Health Benefit Plan of Louisiana, Inc. For Arizona residents: Insured by Humana Insurance Company. For Texas residents: Insured by Humana Insurance Company.
****Humana Inc. and its subsidiaries (“Humana”) do not discriminate on the basis of race, color, national origin, age, disability, or sex.
English: ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call [[Phone]] (TTY: 711).
Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al [[Phone]] (TTY: 711).
繁體中文 (Chinese): 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電[[Phone]] (TTY：711).