Humana Gold Choice H2944-197 (PFFS)
Medicare Plan Details
2021 Plan
Monthly Premium
(select county for price) |

by Humana
Additional Coverage
Hearing
Overall Government Star Rating
3.5out of 5 stars
State: Oklahoma
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B
Plan Details
$19
$19
$0
$0
$6,700 In and Out-of-network
No
Yes
No
No
Medical Benefits
Doctor Services
In-network: $10 copay per visit
Out-of-network: No Data
Out-of-network: No Data
In-network: $40 copay per visit
Out-of-network: No Data
Out-of-network: No Data
Tests, labs, & imaging
In-network: $0-40 copay or 20% coinsurance
Out-of-network: No Data
Out-of-network: No Data
In-network: $0-30 copay or 25% coinsurance
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $40-270 copay or 20-30% coinsurance
Out-of-network: No Data
Out-of-network: No Data
In-network: $10-40 copay or 30% coinsurance
Out-of-network: No Data
Out-of-network: No Data
$90 copay per visit (always covered)
$10-40 copay per visit (always covered)
Hospital Services
In-network: $360 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
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: Not Applicable
In-network: $40-360 copay or 20% coinsurance per visit
Out-of-network: No Data
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
$178 per day for days 21 through 100
Out-of-network: Not Applicable
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
In-network: $265 copay
Out-of-network: No Data
Out-of-network: No Data
Therapy services
In-network: $35-40 copay
Out-of-network: No Data
Out-of-network: No Data
In-network: $35-40 copay
Out-of-network: No Data
Out-of-network: No Data
Mental health services
In-network: $40 copay
Out-of-network: No Data
Out-of-network: No Data
In-network: $40 copay
Out-of-network: No Data
Out-of-network: No Data
In-network: $40 copay
Out-of-network: No Data
Out-of-network: No Data
In-network: $40 copay
Out-of-network: No Data
Out-of-network: No Data
Opioid treatment services
Covered
Other services
In-network: 19% coinsurance per item
Out-of-network: 19% coinsurance per item
Out-of-network: 19% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: No Data
Out-of-network: No Data
In-network: $0 copay or 10-20% coinsurance per item
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Part B Drugs
In-network: 20% coinsurance
Out-of-network: No Data
Out-of-network: No Data
In-network: 20% coinsurance
Out-of-network: No Data
Out-of-network: No Data
Extra Benefits
Hearing
In-network: $40 copay
Out-of-network: No Data
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
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
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