Humana Gold Choice H2944-185 (PFFS)

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Medicare Advantage Plans (Part C)

  • Humana Gold Choice H2944-185 (PFFS)
  • 2012 Plan

  • Overall plan rating Star Star Star (3 out of 5 stars)
    Provided by CMS Oct 2012
Summary
Plan Type Limited Network PFFS
Office Visit for Primary Doctor 20% of the cost for each primary care doctor visit for Medicare-covered benefits.
Office Visit for Specialist 20% of the cost for each specialist visit for Medicare-covered benefits.
Doctor Choice Any Doctor
A Medicare Advantage Private Fee for Service Plan works differently than a Medicare supplement plan. We have network providers that is, providers who have signed contracts with our plans for DME & Lab. These providers have already agreed to see members of our plans. If your provider is not one of our network providers, then the provider is not required to agree to accept the plans terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If this happens, you will need to find another provider that will accept our payment terms and conditions. Providers can find the plans terms and conditions on our website Humana.com or http://apps.humana.com/MedPlans_Provider/PFFSTermsAndConditions.pdf
Annual Deductible $0
Out-of-Pocket Maximum $6,700
Prescription Drug Coverage No
Physical Exams $0 copay for all preventive services covered under Original Medicare at zero cost sharing.
Hospital Services Coverage
Emergency Room $65 copay for Medicare-covered emergency room visits.
$25,000 plan coverage limit for emergency services outside the U.S. every year.
 
Ambulance Services 20% of the cost for Medicare-covered ambulance benefits.
Outpatient Lab/X-Ray 0% to 20% of the cost for Medicare-covered lab services.
0% to 20% of the cost for Medicare-covered diagnostic procedures and tests.
20% of the cost for Medicare-covered X-rays.
Outpatient Surgery 20% of the cost for each Medicare-covered ambulatory surgical center visit.
20% of the cost for each Medicare-covered outpatient hospital facility visit.
Urgent Care Cost sharing is the same as Doctor Office Visit cost sharing.
Hospitalization Days 1 - 60: $1,156 deductible;
– Days 61 - 90: $289 per day;
– Days 91 - 150: $578 per lifetime reserve day.
No limit to the number of days covered by the plan each hospital stay.
Outpatient Rehabilitation Services 20% of the cost for Medicare-covered Occupational Therapy visits.
20% of the cost for Medicare-covered Physical and/or Speech and Language Therapy visits.
Skilled Nursing Facility Plan covers up to 100 days each benefit period.
No prior hospital stay is required.
For SNF stays: Days 1 - 20: $0 copay per day;
Days 21 - 100: $141.50 copay per day.
Home Health Care $0 copay for each Medicare-covered home health visit.
Hospice You must get care from a Medicare-certified hospice.
Prescription Drug Coverage
Prescription Drug Deductible $0
Retail Pharmacy for Prescription Drugs
Not Covered
Not Covered
Not Covered
Not Covered
Not Covered
Mail Order Pharmacy for Prescription Drugs
Not Covered
Not Covered
Not Covered
Not Covered
Not Covered
Additional Coverage
Dental Services In general, preventive dental benefits (such as cleaning) not covered.
20% of the cost for Medicare-covered dental benefits.
Hearing Services In general, routine hearing exams and hearing aids not covered.
20% of the cost for Medicare-covered diagnostic hearing exams.
Vision Services In general, routine eye exams and eye wear not covered.
20% of the cost for one pair of eyeglasses or contact lenses after cataract surgery.
- 0% to 20% of the cost for exams to diagnose and treat diseases and conditions of the eye.
Chiropractic Coverage 20% of the cost for each Medicare-covered visit.
Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers.
Outpatient Mental Health Coverage 20% copay for each Medicare-covered individual therapy visit, 20% copay for each Medicare-covered group therapy visit, 20% copay for each Medicare-covered individual therapy visit with a psychiatrist, 20% copay for each Medicare-covered group therapy visit with a psychiatrist, 20% of the cost for Medicare-covered partial hospitalization program services.
Additional Information
  See more benefit details:
Summary of Benefits
  Medicare & You
  • You can always call our licensed agents at 1 -877-543-9375 (TTY User: 711) Mon - Fri 8AM - 8PM ET, Sat 9AM - 6PM ET if you have questions, need help comparing plans, or to complete your enrollment.
  • You may contact the Humana Medicare Enrollment and Information Center at 1-877-207-0150; TTY Users: 711. Sept. 11, 2011 - Feb. 14, 2012 - 8 a.m. - 8 p.m., seven days a week; Feb. 15 - Sept. 7, 2012, Monday - Friday, 8:00 a.m. to 8:00 p.m., Local time. Humana is a Medicare Advantage organization with a Medicare contract.
  • Limitations, copayments, and restrictions may apply.
  • Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • You must continue to pay your Medicare Part B premium.
  • You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your Medicaid Office.
  • Medicare beneficiaries may also enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • For Non-network PFFS Plans: A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your provider is not required to agree to accept the plan's terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your provider does not agree to accept our payment terms and conditions of payment, they may choose not to provide health care services to you, except in emergencies. If this happens, you will need to find another provider that will accept our payment terms and conditions. Providers can find the plan's terms and conditions on the plan website.
  • For Network and partial network PFFs Plans: A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. We have network providers (that is, providers who have signed contracts with our plan). Full network PFFS plan provide coverage for all services covered under Original Medicare and partial network PFFS plans may cover certain categories of services for which network providers are available. These providers have already agreed to see members of the plan. If your provider is not one of the network providers, then the provider is not required to agree to accept the plan's terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your provider does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. If this happens, you will need to find another provider that will accept our payment terms and conditions. Providers can find the plan's terms and conditions on the plan website.
  • Plan Ratings are assessed each year by Center for Medicare & Medicaid Services (CMS) and may change from one year to the next.
  • Not every plan is available statewide or in all service areas.
Last Updated: 3/8/2013
Y0040_MULTIPLAN_GHHH66GHH_F Approved
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