Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP)

Medicare Plan Details (2023 Plan)


Monthly Premium

 

by Humana
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 4.0
out of 5 stars

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Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

 

$0
$0
$0
$0
$8,300 In-network
No
Yes
Yes
Yes

Doctor Services

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Tests, labs, & imaging

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
$0 copay
$0 copay

Hospital Services

In-network: $0 copay
Out-of-network: Not Applicable
In-network: $0 copay
Out-of-network: No Data

Skilled nursing facility

In-network: $0 copay
Out-of-network: Not Applicable

Preventive services

In-network: $0 copay
Out-of-network: No Data

Ambulance

In-network: $0 copay
Out-of-network: No Data

Therapy services

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Mental health services

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Opioid treatment services

Covered

Other services

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$4.15 copay or 5% (whichever costs more)

Brand-name drugs :
$10.35 copay or 5% (whichever costs more)

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Hearing

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Preventive Dental

In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay

Vision

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Not covered
Limited coverage
Not covered
Limited coverage
Limited coverage
Limited coverage
 4
 3
 4
 4
 3
 5
 3.5
 5
 3
 4
 3

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