Humana Gold Plus H5619-066 (HMO)


Medicare Plan Details

2021 Plan
Monthly Premium
(select county for price)

 

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

State: Maine

Select your county to view the price for this plan

 


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
$510 In-network
$7,550 In-network
No
Yes
Yes
No

Medical Benefits

Doctor Services

$0 copay
$50 copay per visit

Tests, labs, & imaging

$0-100 copay
$0-50 copay
$0-400 copay
$0-100 copay
$90 copay per visit (always covered)
$0-50 copay per visit (always covered)

Hospital Services

$795 per stay
$50-500 copay per visit

Skilled nursing facility

$0 per day for days 1 through 20
$184 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

$290 copay

Therapy services

$40 copay
$40 copay

Mental health services

$40 copay
$40 copay
$40 copay
$40 copay

Opioid treatment services

Covered

Other services

15% coinsurance per item
15% coinsurance per item
$0 copay or 10-20% coinsurance per item

Prescription Drug Benefits

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$10.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$3.70 copay or 5% (whichever costs more)

Brand-name drugs :
$9.20 copay or 5% (whichever costs more)

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier26%

Part B Drugs

12% coinsurance
12% coinsurance

Extra Benefits

Hearing

$50 copay
Not covered
Not covered
Not covered
Not covered

Preventive Dental

Not covered
Not covered
Not covered
Not covered

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

$0 copay
$0 copay
$0 copay
Not covered
Not covered
Not covered

Other benefits

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

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