2021 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan) | ||||
Location: | Kane, Illinois | ||||
Plan ID: | H0336 - 001 - 0 Click to see other plans | ||||
Member Services: | 1-800-787-3311 TTY users 711 | ||||
— Enrollment Options — | |||||
Medicare Contact Information: | 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 | ||||
Speak to a licensed sales agent to learn more and enroll. Call Medicare Solutions at 855-373-9484 / TTY 711 Monday ‐ Friday 8:30am — 10pm EST | |||||
Email a copy of the Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 (see Plan Premium Details below) | ||||
Annual Deductible: | $0 | ||||
Health Plan Type: | MMP | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $0 | ||||
Additional Gap Coverage? | All Generics, All Brands | ||||
Total Number of Formulary Drugs: | 3,129 drugs | Browse the Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan) Formulary | |||
This plan has drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | Cost-sharing data coming soon. | ||||
• Number of Drugs per Tier: | |||||
Plan's Pharmacy Search: | http://www.humana.com/medicare/medicaid-dual/illinois/pharmacy/ | ||||
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in Kane, Illinois: | 330 members | ||||
Number of Members enrolled in this plan in Illinois: | 8,766 members | ||||
Number of Members enrolled in this plan in (H0336 - 001): | 9,016 members | ||||
Plan’s Summary Star Rating: | Insufficient data to rate this plan. | ||||
• Customer Service Rating: | Insufficient data to rate this plan. | ||||
• Member Experience Rating: | Insufficient data to rate this plan. | ||||
• Drug Cost Accuracy Rating: | Insufficient data to rate this plan. | ||||
— Plan Premium Details — | |||||
Monthly Premium with Extra Help Low-Income Subsidy (LIS):❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $0.00 | $0.00 | $0.00 | $0.00 |
— Plan Health Benefits — | |||||
** Base Plan ** | |||||
Premium | |||||
• Health plan premium: $0 | |||||
• Drug plan premium: $0 | |||||
• You must continue to pay your Part B premium. | |||||
• Part B premium reduction: No | |||||
Deductible | |||||
• Health plan deductible: $0 | |||||
• Other health plan deductibles: In-network: No | |||||
• Drug plan deductible: No annual deductible | |||||
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | |||||
• Not Applicable | |||||
Optional supplemental benefits | |||||
• No | |||||
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions? | |||||
• In-network: No | |||||
Doctor visits | |||||
• Primary: $0 copay | |||||
• Specialist: $0 copay (authorization and referral required) | |||||
Diagnostic procedures/lab services/imaging | |||||
• Diagnostic tests and procedures: $0 copay (authorization and referral required) | |||||
• Lab services: $0 copay (authorization and referral required) | |||||
• Diagnostic radiology services (e.g., MRI): $0 copay (authorization and referral required) | |||||
• Outpatient x-rays: $0 copay (authorization and referral required) | |||||
Emergency care/Urgent care | |||||
• Emergency: $0 copay | |||||
• Urgent care: $0 copay | |||||
Inpatient hospital coverage | |||||
• $0 copay (authorization and referral required) | |||||
Outpatient hospital coverage | |||||
• $0 copay (authorization and referral required) | |||||
Skilled Nursing Facility | |||||
• $0 copay (authorization and referral required) | |||||
Preventive care | |||||
• $0 copay | |||||
Ground ambulance | |||||
• $0 copay | |||||
Rehabilitation services | |||||
• Occupational therapy visit: $0 copay (authorization and referral required) | |||||
• Physical therapy and speech and language therapy visit: $0 copay (authorization and referral required) | |||||
Mental health services | |||||
• Inpatient hospital - psychiatric: $0 copay (authorization and referral required) | |||||
• Outpatient group therapy visit with a psychiatrist: $0 copay (authorization and referral required) | |||||
• Outpatient individual therapy visit with a psychiatrist: $0 copay (authorization and referral required) | |||||
• Outpatient group therapy visit: $0 copay (authorization and referral required) | |||||
• Outpatient individual therapy visit: $0 copay (authorization and referral required) | |||||
Medical equipment/supplies | |||||
• Durable medical equipment (e.g., wheelchairs, oxygen): $0 copay (authorization required) | |||||
• Prosthetics (e.g., braces, artificial limbs): $0 copay (authorization required) | |||||
• Diabetes supplies: $0 copay (authorization required) | |||||
Hearing | |||||
• Hearing exam: $0 copay | |||||
• Fitting/evaluation: $0 copay (limits apply) | |||||
• Hearing aids: $0 copay (limits apply, authorization and referral required) | |||||
Preventive dental | |||||
• Oral exam: $0 copay (limits apply) | |||||
• Cleaning: $0 copay (limits apply) | |||||
• Fluoride treatment: Not covered | |||||
• Dental x-ray(s): Not covered | |||||
Comprehensive dental | |||||
• Non-routine services: Not covered | |||||
• Diagnostic services: $0 copay (limits apply, authorization and referral required) | |||||
• Restorative services: $0 copay (limits apply, authorization and referral required) | |||||
• Endodontics: $0 copay (limits apply, authorization and referral required) | |||||
• Periodontics: $0 copay (limits apply, authorization and referral required) | |||||
• Extractions: $0 copay (limits apply, authorization and referral required) | |||||
• Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay (limits apply, authorization and referral required) | |||||
Vision | |||||
• Routine eye exam: $0 copay (limits apply) | |||||
• Other: $0 copay (limits apply) | |||||
• Contact lenses: $0 copay (limits apply) | |||||
• Eyeglasses (frames and lenses): $0 copay (limits apply) | |||||
• Eyeglass frames: Not covered | |||||
• Eyeglass lenses: $0 copay (limits apply) | |||||
• Upgrades: Not covered | |||||
Wellness programs (e.g., fitness, nursing hotline) | |||||
• Covered | |||||
Transportation | |||||
• $0 copay (authorization required) | |||||
Foot care (podiatry services) | |||||
• Foot exams and treatment: $0 copay (authorization and referral required) | |||||
• Routine foot care: $0 copay (limits apply, authorization and referral required) | |||||
Medicare Part B drugs | |||||
• Chemotherapy: $0 copay (authorization required) | |||||
• Other Part B drugs: $0 copay (authorization required) |
Humana Mri Copay Programs
Humana Gold Plus® is a Medicare Advantage Health Maintenance Organization (HMO) plan with a wide range of coverage for seniors. Humana has contracted with Medicare to provide you with services that are not covered by your Medicare Part A and Part B benefits under original Medicare.
For the 2021 plan year, Humana will cover out-of-pocket costs for COVID-19 treatment for all Humana Medicare Advantage medical plan members. Members will have no copays, deductibles or coinsurance out-of-pocket costs for covered services for treatment of confirmed cases of COVID-19, regardless of where the treatment takes place. Plan details for Humana LCMC Advantage H1951-051 (HMO), a 2021 Medicare Advantage Plan. Lab Services $40 copay $10 copay If performed during PCP or Specialist office visit, no additional fee if in-network lab used. Diagnostic radiology services (such as MRIs, CT Scans) $100 copay $100 copay In-network: 30% coinsurance after deductible Therapeutic Radiology Services (such as radiation treatment for cancer). HumanaChoice Florida H5216-072 (PPO) 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.
Does Humana Pay For Mri
2021 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Humana Gold Plus H0028-021 (HMO) | ||||
Location: | Pima, Arizona | ||||
Plan ID: | H0028 - 021 - 0 Click to see other plans | ||||
Member Services: | 1-800-457-4708 TTY users 711 | ||||
— Enrollment Options — | |||||
Medicare Contact Information: | 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 | ||||
Medicare plan advice at no cost from licensed insurance agents. Call: 888-205-9813 / TTY 711 Monday‐Friday 8am — 8pm ET | |||||
Email a copy of the Humana Gold Plus H0028-021 (HMO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 (see Plan Premium Details below) | ||||
Annual Deductible: | $0 | ||||
Annual Initial Coverage Limit (ICL): | $4,130 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $2,800 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,397 drugs | Browse the Humana Gold Plus H0028-021 (HMO) Formulary | |||
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
This plan offers select insulin at a $35 copay. Learn more. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $2.00 | $10.00 | $42.00 | $95.00 | 33% |
• Number of Drugs per Tier: | 304 | 600 | 773 | 1076 | 644 |
Plan's Pharmacy Search: | http://www.humana.com/Medicare/medicare_prescription_drugs/ | ||||
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in Pima, Arizona: | 11,430 members | ||||
Number of Members enrolled in this plan in (H0028 - 021): | 14,462 members | ||||
Plan’s Summary Star Rating: | 4 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 4 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows:❔ | Total Premium | Part C Premium | Part D Base Premium | Part D Supplemental Premium | |
$0.00 | $0.00 | $0.00 | $0.00 | ||
Monthly Premium with Extra Help Low-Income Subsidy (LIS):❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $0.00 | $0.00 | $0.00 | $0.00 | |
Total Monthly Premium with LIS (Parts C & D): | $0.00 | $0.00 | $0.00 | $0.00 |
Humana Mri Copay Application
— Plan Health Benefits — | |||||
** Base Plan ** | |||||
Premium | |||||
• Health plan premium: $0 | |||||
• Drug plan premium: $0 | |||||
• You must continue to pay your Part B premium. | |||||
• Part B premium reduction: No | |||||
Deductible | |||||
• Health plan deductible: $0 | |||||
• Other health plan deductibles: In-network: No | |||||
• Drug plan deductible: No annual deductible | |||||
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | |||||
• $2,800 In-network | |||||
Optional supplemental benefits | |||||
• Yes | |||||
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions? | |||||
• In-network: No | |||||
Doctor visits | |||||
• Primary: $0 copay | |||||
• Specialist: $30 copay per visit (authorization required) | |||||
Diagnostic procedures/lab services/imaging | |||||
• Diagnostic tests and procedures: $0-150 copay (authorization required) | |||||
• Lab services: $0 copay (authorization required) | |||||
• Diagnostic radiology services (e.g., MRI): $0-275 copay (authorization required) | |||||
• Outpatient x-rays: $0-105 copay (authorization required) | |||||
Emergency care/Urgent care | |||||
• Emergency: $120 copay per visit (always covered) | |||||
• Urgent care: $0-45 copay per visit (always covered) | |||||
Inpatient hospital coverage | |||||
• $180 per day for days 1 through 7 $0 per day for days 8 through 90 $0 per day for days 91 and beyond (authorization required) | |||||
Outpatient hospital coverage | |||||
• $20-180 copay per visit (authorization required) | |||||
Skilled Nursing Facility | |||||
• $0 per day for days 1 through 20 $178 per day for days 21 through 100 (authorization required) | |||||
Preventive care | |||||
• $0 copay | |||||
Ground ambulance | |||||
• $195 copay | |||||
Rehabilitation services | |||||
• Occupational therapy visit: $40 copay (authorization required) | |||||
• Physical therapy and speech and language therapy visit: $40 copay (authorization required) | |||||
Mental health services | |||||
• Inpatient hospital - psychiatric: $312 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) | |||||
• Outpatient group therapy visit with a psychiatrist: $20 copay (authorization required) | |||||
• Outpatient individual therapy visit with a psychiatrist: $20 copay (authorization required) | |||||
• Outpatient group therapy visit: $20 copay (authorization required) | |||||
• Outpatient individual therapy visit: $20 copay (authorization required) | |||||
Medical equipment/supplies | |||||
• Durable medical equipment (e.g., wheelchairs, oxygen): 20% coinsurance per item (authorization required) | |||||
• Prosthetics (e.g., braces, artificial limbs): 20% coinsurance per item (authorization required) | |||||
• Diabetes supplies: $0 copay or 10-20% coinsurance per item (authorization required) | |||||
Hearing | |||||
• Hearing exam: $30 copay (authorization required) | |||||
• Fitting/evaluation: $0 copay (limits apply, authorization required) | |||||
• Hearing aids: $699-999 copay (limits apply) | |||||
Preventive dental | |||||
• Oral exam: $0 copay (limits apply) | |||||
• Cleaning: $0 copay (limits apply) | |||||
• Fluoride treatment: Not covered | |||||
• Dental x-ray(s): $0 copay (limits apply) | |||||
Comprehensive dental | |||||
• Non-routine services: Not covered | |||||
• Diagnostic services: Not covered | |||||
• Restorative services: Not covered | |||||
• Endodontics: Not covered | |||||
• Periodontics: Not covered | |||||
• Extractions: Not covered | |||||
• Prosthodontics, other oral/maxillofacial surgery, other services: Not covered | |||||
Vision | |||||
• Routine eye exam: $0 copay (limits apply, authorization required) | |||||
• Other: Not covered | |||||
• Contact lenses: $0 copay (limits apply, authorization required) | |||||
• Eyeglasses (frames and lenses): $0 copay (limits apply, authorization required) | |||||
• Eyeglass frames: Not covered | |||||
• Eyeglass lenses: Not covered | |||||
• Upgrades: Not covered | |||||
Wellness programs (e.g., fitness, nursing hotline) | |||||
• Covered | |||||
Transportation | |||||
• $0 copay (limits apply, authorization required) | |||||
Foot care (podiatry services) | |||||
• Foot exams and treatment: $30 copay (authorization required) | |||||
• Routine foot care: $0 copay (limits apply, authorization required) | |||||
Medicare Part B drugs | |||||
• Chemotherapy: 20% coinsurance (authorization required) | |||||
• Other Part B drugs: 20% coinsurance (authorization required) | |||||
Package #1 | |||||
• Monthly Premium: $30.40 | |||||
• Deductible: | |||||
Package #2 | |||||
• Monthly Premium: $40.10 | |||||
• Deductible: |