Humana Gold Choice H8145-120 (PFFS)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Humana
Additional Coverage
Vision
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

 

$59
$59
$0
$150 In and Out-of-network
$6,700 In and Out-of-network
No
No
Yes
No

Medical Benefits

Doctor Services

In-network: $20 per visit
Out-of-network: 40% per visit
In-network: $50 per visit
Out-of-network: 40% per visit

Tests, labs, & imaging

In-network: $0-50 or 20%
Out-of-network: 40%
In-network: $0-30 or 25%
Out-of-network: 40%
In-network: $50-360 or 20%
Out-of-network: 40%
In-network: $20-50 or 20%
Out-of-network: 40%
$90 per visit (always covered)
$20-50 or 40% 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: 40% per stay
In-network: $50 or 20% per visit
Out-of-network: 40% per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: 40% per stay

Preventive services

In-network: $0 copay
Out-of-network: $0 or 40%

Ambulance

In-network: $265
Out-of-network: $265

Therapy services

In-network: $35-40
Out-of-network: 40%
In-network: $35-40
Out-of-network: 40%

Mental health services

In-network: $40
Out-of-network: 40%
In-network: $40
Out-of-network: 40%
In-network: $40
Out-of-network: 40%
In-network: $40
Out-of-network: 40%

Opioid treatment services

Covered

Other services

In-network: 20% per item
Out-of-network: 20% per item
In-network: 20% per item
Out-of-network: 20-40% per item
In-network: $0 or 10-20% per item
Out-of-network: 20-40% 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: 20%
In-network: 20%
Out-of-network: 20%

Extra Benefits

Hearing

In-network: $50
Out-of-network: 40%
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

In-network: $0 copay
Out-of-network: $0 copay
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
 3.5
 3
 3
 3
 4
 5

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