Humana Gold Choice H2944-013 (PFFS)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Humana
Additional Coverage

(none)

Overall Government Star Rating
 3.5
out of 5 stars

State: Oklahoma

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

 

$108
$68
$40
$0
$6,700 In and Out-of-network
No
No
No
No

Medical Benefits

Doctor Services

In-network: $15 per visit
Out-of-network: No Data
In-network: $50 per visit
Out-of-network: No Data

Tests, labs, & imaging

In-network: $0-50 or 30%
Out-of-network: No Data
In-network: $0-30 or 30%
Out-of-network: $0 copay
In-network: $50-295 or 25-30%
Out-of-network: No Data
In-network: $15-50 or 25-30%
Out-of-network: No Data
$90 per visit (always covered)
$15-50 per visit (always covered)

Hospital Services

In-network: $295 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: Not Applicable
In-network: $45 or 30% per visit
Out-of-network: No Data

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: Not Applicable

Preventive services

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

Ambulance

In-network: $265
Out-of-network: No Data

Therapy services

In-network: $35-40
Out-of-network: No Data
In-network: $35-40
Out-of-network: No Data

Mental health services

In-network: $40
Out-of-network: No Data
In-network: $40
Out-of-network: No Data
In-network: $40
Out-of-network: No Data
In-network: $40
Out-of-network: No Data

Opioid treatment services

Covered

Other services

In-network: 14% per item
Out-of-network: 15% per item
In-network: 20% per item
Out-of-network: No Data
In-network: $0 or 10-20% per item
Out-of-network: 20% 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 :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier29%

Part B Drugs

In-network: 20%
Out-of-network: No Data
In-network: 20%
Out-of-network: No Data

Extra Benefits

Hearing

In-network: $50
Out-of-network: No Data
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

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

Other benefits

Not covered
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
 3
 2
 2
 4
 4
 4
 4
 5
 4
 3
 4

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