Humana Gold Plus H1036-143 (HMO)

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric; for days 1-7, there is a $300 copay, and for days 8-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $300, observation services have a $300 copay, and ambulatory surgical center services have no copay.

Outpatient substance abuse services have a copay between $10 and $100 for individual and group sessions, while outpatient blood services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by the Humana Gold Plus H1036-143 (HMO) plan, with a $35 copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Humana Gold Plus H1036-143 (HMO) plan. Ground ambulance services have a copay of $0-$255, while air ambulance services have a 20% coinsurance. 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 the Humana Gold Plus H1036-143 (HMO) plan. Emergency Services have a $125 copay, and no coinsurance. Urgently Needed Services have a $10 copay, and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay, and no coinsurance.

Primary Care See details

Under the Humana Gold Plus H1036-143 (HMO) plan, primary care physician services have no copay, while chiropractic services have a $10 copay. Occupational Therapy Services have a copay between $5 and $10. Physician Specialist Services have a $15 copay, and mental health specialty services have a $10 copay for individual and group sessions. Other health care professional visits have a copay between $0 and $15, and psychiatric services individual and group sessions have a $10 copay. Physical therapy and speech-language pathology services have a copay between $5 and $10, and additional telehealth benefits have a copay between $0 and $15. Opioid Treatment Program Services have a copay between $10 and $100. Routine chiropractic care and podiatry services are not covered.

Preventive Services See details

Preventive services include no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additionally, there is no copay for In-Home Support Services, smoking cessation counseling, and fitness benefits such as memory fitness. Other preventive services require a copay, and some services such as health education, in-home safety assessments, and others are not covered.

Hearing Services See details

The Humana Gold Plus H1036-143 (HMO) plan covers hearing exams for a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $199 and $1299 for all types, but inner ear, outer ear, and over-the-ear hearing aids are not covered. Over-the-counter hearing aids are covered with a maximum benefit of $30 every month.

Vision Services See details

Vision services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$15, while routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses (lenses and frames), has no copay, with a combined maximum plan benefit coverage of $300 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.

Dental Services See details

The Humana Gold Plus H1036-143 (HMO) plan covers dental services with a $15 copay for Medicare Dental Services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, periodontics, and oral and maxillofacial surgery are covered with no copay. Prosthodontics, removable has a 30% coinsurance and no copay. Fluoride treatment, endodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered under the Humana Gold Plus H1036-143 (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, and coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered under the Humana Gold Plus H1036-143 (HMO) plan. This benefit requires prior authorization and a doctor's referral, with a coinsurance of 20%.

Medical Equipment See details

Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and no copay, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a maximum copay of $225, Lab Services with no copay, Diagnostic Radiological Services with a maximum copay of $295, Therapeutic Radiological Services with a copay of at most $50 and 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization and a doctor's referral.

Home Health Services See details

Home Health Services are covered by the Humana Gold Plus H1036-143 (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 plan does not cover the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization and a doctor's referral are required.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H1036-143 (HMO) plan, but require prior authorization. You will have no copay for days 1-20, and a $160 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.

Other Services See details

Other Services include acupuncture and over-the-counter (OTC) items. Acupuncture has no copay, and OTC items are covered with a maximum benefit of $30.00 per month.