Humana Gold Plus H6622-056 (HMO)

Medicare Plan Details (2022 Plan)


Monthly Premium

 

by Humana
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 4.5
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
$999 In-network
No
Yes
Yes
Yes

Doctor Services

$0 copay
$0 copay

Tests, labs, & imaging

$0-30 copay
$0 copay
$0-5 copay
$5 copay
$120 copay per visit (always covered)
$0-10 copay per visit (always covered)

Hospital Services

$0 copay per stay
$0-30 copay per visit

Skilled nursing facility

$0 per day for days 1 through 20
$125 per day for days 21 through 40
$0 per day for days 41 through 100

Preventive services

$0 copay

Ambulance

$180 copay

Therapy services

$0 copay
$0 copay

Mental health services

$30 copay
$30 copay
$30 copay
$30 copay

Opioid treatment services

Covered

Other services

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

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 :
$3.95 copay or 5% (whichever costs more)

Brand-name drugs :
$9.85 copay or 5% (whichever costs more)

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%

Part B Drugs

20% coinsurance
20% coinsurance

Hearing

$0 copay
$0 copay
$499-799 copay

Preventive Dental

$0 copay
$0 copay
$0 copay
$0 copay

Comprehensive dental

0% coinsurance
Not covered
0% coinsurance
0% coinsurance
0% coinsurance
0% coinsurance
0% coinsurance

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
 4.5
 4
 4
 4
 5
 5
 4.5
 5
 5
 4
 4

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