Humana Gold Choice H2944-197 (PFFS)
Medicare Plan Details
2020 Plan
Monthly Premium
| (select county for price) |
by Humana
Additional Coverage
(none)
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
$89
$89
$0
$0
$6,700 In and Out-of-network
No
No
No
No
Medical Benefits
Doctor Services
In-network: $20 per visit
Out-of-network: No Data
Out-of-network: No Data
In-network: $50 per visit
Out-of-network: No Data
Out-of-network: No Data
Tests, labs, & imaging
In-network: $0-50 or 20%
Out-of-network: No Data
Out-of-network: No Data
In-network: $0-30 or 25%
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $50-360 or 20-30%
Out-of-network: No Data
Out-of-network: No Data
In-network: $20-50 or 30%
Out-of-network: No Data
Out-of-network: No Data
$90 per visit (always covered)
$20-50 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: $50-360 or 20% 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
Out-of-network: No Data
Out-of-network: No Data
Therapy services
In-network: $35-40
Out-of-network: No Data
Out-of-network: No Data
In-network: $35-40
Out-of-network: No Data
Out-of-network: No Data
Mental health services
In-network: $40
Out-of-network: No Data
Out-of-network: No Data
In-network: $40
Out-of-network: No Data
Out-of-network: No Data
In-network: $40
Out-of-network: No Data
Out-of-network: No Data
In-network: $40
Out-of-network: No Data
Out-of-network: No Data
Opioid treatment services
Covered
Other services
In-network: 19% per item
Out-of-network: 19% per item
Out-of-network: 19% per item
In-network: 20% per item
Out-of-network: No Data
Out-of-network: No Data
In-network: $0 or 10-20% per item
Out-of-network: 20% per item
Out-of-network: 20% per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Part B Drugs
In-network: 20%
Out-of-network: No Data
Out-of-network: No Data
In-network: 20%
Out-of-network: No Data
Out-of-network: No Data
Extra Benefits
Hearing
In-network: $50
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
Not covered
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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