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Humana Gold Plus SNP-DE H0028-015 (HMO D-SNP)
Medicare Plan Details (2022 Plan)
Monthly Premium

by Humana
Additional Coverage
HearingVisionDental
Overall Government Star Rating
4.5out of 5 stars
Ready to Enroll Online?
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
Plan Details
Medical Benefits
Doctor Services
$0 copay
$0 copay
Tests, labs, & imaging
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
Hospital Services
$0 copay
$0 copay
Skilled nursing facility
$0 copay
Preventive services
$0 copay
Ambulance
$0 copay
Therapy services
$0 copay
$0 copay
Mental health services
$0 copay
$0 copay
$0 copay
$0 copay
Opioid treatment services
Covered
Other services
$0 copay
$0 copay
$0 copay
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
---|---|---|---|
Preferred Generic | $0.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
Generic | $20.00 copay | ||
Preferred Brand | $47.00 copay | ||
Non-Preferred Drug | $100.00 copay | ||
Specialty Tier | 28% |
Part B Drugs
$0 copay
$0 copay
Extra Benefits
Hearing
$0 copay
$0 copay
$0 copay
Preventive Dental
$0 copay
$0 copay
$0 copay
$0 copay
Comprehensive dental
$0 copay
Not covered
$0 copay
Not covered
$0 copay
$0 copay
$0 copay
Vision
$0 copay
$0 copay
$0 copay
Not covered
Not covered
Not covered
Other benefits
Limited coverage
Limited coverage
Limited coverage
Not covered
Limited coverage
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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