|Part D Benefit:||Yes|
|Rx Gap Coverage:||N|
Humana Gold Plus H1036-233 is a Health Maintenance Organization (HMO) Medicare Advantage plan, by Humana, available in Wake County, North Carolina. It offers all of the basic benefits of Original Medicare and may include additional coverage.
With an HMO plan, like this one from Humana, your out-of-pocket costs are much lower than Original Medicare. That's the big advantage.
IMPORTANT: You must use providers in the Humana network to avoid incurring additional costs. You are responsible for all costs incurred out of network. Referrals are generally required to see specialists.
This plan has a zero dollar premium!
If you enroll in the Humana Gold Plus H1036-233 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.
Your monthly premium is independent of the healthcare services you use. When you see your doctor, or if you are admitted into the hospital for treatment, you have copayments. Your prescriptions also have copayments.
Maximum Out-of-Pocket Limit
All 2018 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 $4,900. 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 $4,900. 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.
Coverage, Copayments & Coinsurance
The Humana Gold Plus H1036-233 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.
Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:
|Primary Care Doctor:||$0 co-payment|
|Physician Specialist:||$35 co-payment|
|Occupational Therapist:||$10 to $35 co-payment|
|Physical Therapist:||$35 co-payment|
|Speech Terapist:||$35 co-payment|
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 4: $100
- Day 5 to 90: $0
The following preventative healthcare services are covered 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
Prescription Drug Coverage
This plan includes Medicare Part D coverage for your prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The Part D deductible on plan is $195.00. This is the amount you will pay until the plan begins to pay its portion.
Medicare Plan Rating
Medicare gave the Humana Gold Plus H1036-233 plan an average rating of -1.0 out of 5 stars. This rating is , by Medicare's definition.
Each Medicare Advantage plan receives a 1.0 to 5.0 star rating by Medicare (annually). The quality assessment of plans helps people considering enrollment. A plan with 5 stars has the highest quality.
Compare Humana Gold Plus H1036-233 with these top rated plans available in Wake County:
- Blue Medicare PPO Enhanced
- Blue Medicare HMO Medical Only
- Blue Medicare HMO Essential
- Aetna Medicare Value Plan
- Aetna Medicare Prime Plan
Humana Gold Plus H1036-233 Availability
Humana Gold Plus H1036-233 is available in Rolesville, Fuquay Varina, Holly Springs, Morrisville, Knightdale, Garner, New Hill, Wake Forest, Apex, Cary, Wendell, Willow Spring, Raleigh, Zebulon, and all other areas of Wake County.
This page was last updated on 10/14/2017.
Plan data on Medicare-Plans.net comes from CMS.gov and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.
This page is a brief summary, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly.
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