Humana Gold Plus H0028-062 (HMO)

Inpatient Hospital See details

Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $350 copay for days 1-6, and no copay for days 7-90, with no coinsurance; additional days (91-999) have no copay. For Inpatient Hospital Psychiatric, you'll pay a $350 copay for days 1-6, and no copay for days 7-90, with no coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient services include coverage for all outpatient hospital services, with copays ranging from $0 to $350, and observation services with a $350 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $40 copay for both individual and group sessions. Outpatient blood services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by the Humana Gold Plus H0028-062 (HMO) plan with a $100 copay, and prior authorization is required.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Humana Gold Plus H0028-062 (HMO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a $630 copay; there is no coinsurance for either service. Transportation Services to any health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under this plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.

Primary Care See details

Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, but Routine Care is not covered.

Occupational Therapy Services have a $40 copay. Physician Specialist Services have a $40 copay.

Mental Health Specialty Services, including both individual and group sessions, have a $40 copay. Podiatry Services have a $40 copay. Other Health Care Professional Services have a copay between $0 and $40. Psychiatric Services, including both individual and group sessions, have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits have a copay between $0 and $55. Opioid Treatment Program Services have a $40 copay.

Preventive Services See details

Preventive Services include a yearly physical exam with no copay, and additional preventive services that require prior authorization. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay.

Hearing Services See details

Hearing Services include hearing exams with a $40 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999 for two hearing aids per year, while OTC hearing aids are covered up to $45 every three months.

Vision Services See details

Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $40, and routine eye exams have no copay. Eyewear includes contact lenses and eyeglasses (lenses and frames) with no copay, and a combined maximum benefit of $100 per year; however, eyeglass lenses, eyeglass frames and upgrades are not covered.

Dental Services See details

The Humana Gold Plus H0028-062 (HMO) plan covers Medicare dental services with a $40 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatments, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered under the Humana Gold Plus H0028-062 (HMO) plan. For Medicare Part B Insulin Drugs, you will pay a $35 copay, and the coinsurance can range from 0% to 20%. The plan also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with coinsurance ranging from 0% to 20%.

Dialysis Services See details

Dialysis Services are covered under the Humana Gold Plus H0028-062 (HMO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.

Medical Equipment See details

Medical equipment is covered under the Humana Gold Plus H0028-062 (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while durable medical equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance for Medicare-covered devices and supplies, and diabetic equipment, including supplies and therapeutic shoes/inserts, has a 20% coinsurance with required authorization.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services include coverage for all diagnostic services and lab services, with a copay for each service ranging from $0 to $100, and for diagnostic radiological services, with a copay up to $350. All outpatient X-Ray services have no copay, and therapeutic radiological services have a coinsurance of at least 20%.

Home Health Services See details

Home Health Services are covered by the Humana Gold Plus H0028-062 (HMO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are covered, but the specific sub-services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H0028-062 (HMO), with a copay of $10 for days 1-20, and $214 for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.

Other Services See details

Other Services include acupuncture with a $40 copay, up to 20 treatments per year, and Over-the-Counter (OTC) Items with a $45 allowance every three months. The plan also covers a meal benefit with no copay. However, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.