Humana Copay Plans




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.

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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.



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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 servicesNot covered
EndodonticsNot covered
Extractions55% coinsurance (Out-of-Network)
Extractions0% coinsurance
Non-routine servicesNot covered
PeriodonticsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Restorative services55% coinsurance (Out-of-Network)
Restorative services0% 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 careNot 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


Chemotherapy20% coinsurance
Other Part B drugs20% coinsurance


Mental Health Services


Inpatient hospital - psychiatricNot 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

Humana copay plans 2019

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 treatmentNot 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

Humana

Transportation


Not covered


Vision


Contact lenses$0 copay
Eyeglass framesNot covered
Eyeglass lensesNot covered
Eyeglasses (frames and lenses)$0 copay
OtherNot covered
Routine eye exam$0 copay
UpgradesNot 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


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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,

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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.

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