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

3.5

out 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

Monthly Premium

$19

Health Portion of Premium

$19

Drug Portion of Premium

Health Plan Deductible

Health Plan Max Out-of-Pocket

$6,700 In and Out-of-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Dental Coverage included

Doctor Lookup Link

http://www.humana.com/medicare

Plan Link

http://www.humana.com/medicare

Medical Benefits

Doctor Services

Primary doctor visit

In-network: $10 copay per visit
Out-of-network: No Data

Specialist visit

In-network: $40 copay per visit
Out-of-network: No Data

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $0-40 copay or 20% coinsurance
Out-of-network: No Data

Lab services

In-network: $0-30 copay or 25% coinsurance
Out-of-network: $0 copay

Diagnostic radiology services (like MRI)

In-network: $40-270 copay or 20-30% coinsurance
Out-of-network: No Data

Outpatient x-rays

In-network: $10-40 copay or 30% coinsurance
Out-of-network: No Data

Emergency care

$90 copay per visit (always covered)

Urgent care

$10-40 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

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

Outpatient hospital coverage

In-network: $40-360 copay or 20% coinsurance 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

Ground ambulance

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

Therapy services

Occupational therapy visit

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

Physical therapy & speech & language therapy visit

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

Mental health services

Outpatient group therapy with a psychiatrist

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

Outpatient individual therapy with a psychiatrist

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

Outpatient group therapy visit

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

Outpatient individual therapy visit

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

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 19% coinsurance per item
Out-of-network: 19% coinsurance per item

Prosthetics (like braces, artificial limbs)

In-network: 20% coinsurance per item
Out-of-network: No Data

Diabetes supplies

In-network: $0 copay or 10-20% 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

Chemotherapy drugs

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

Other Part B drugs

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

Extra Benefits

Hearing

Hearing exam

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

Fitting/evaluation

Not covered

Hearing aids - Inner ear

Not covered

Hearing aids - Outer ear

Not covered

Hearing aids - Over the ear

Not covered

Preventive Dental

Oral exam

Not covered

Cleaning

Not covered

Fluoride treatment

Not covered

Dental x-rays

Not covered

Comprehensive dental

Non-routine services

Not covered

Diagnostic services

Not covered

Restorative services

Not covered

Endodontics

Not covered

Periodontics

Not covered

Extractions

Not covered

Prosthodontics, other oral/maxillofacial surgery, other services

Not covered

Vision

Routine eye exam

Not covered

Contact lenses

Not covered

Eyeglasses (frames & lenses)

Not covered

Eyeglass frames (only)

Not covered

Eyeglass lenses (only)

Not covered

Upgrades

Not covered

Other benefits

Fitness benefit

Not covered

Over the counter drug benefits

Limited coverage

In-home support services

Not covered

Home and bathroom safety devices

Not covered

Meals for short duration

Limited coverage

Annual physical exams

Limited coverage

Telehealth

Limited coverage

Summary rating of health plan quality

3.5

Staying healthy: screenings, tests, & vaccines

Managing chronic (long term) conditions

Member experience with health plan

Member complaints & changes in the health plan's performance

Health plan customer service

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