Humana Gold Plus H4461-037 (HMO)
Medicare Plan Details
2022 Plan
Monthly Premium
| (select county for price) |
by Humana
Additional Coverage
HearingVisionDental
Overall Government Star Rating
5.0out of 5 stars
State: Tennessee
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
Plan Details
Medical Benefits
Doctor Services
$0 copay
$25 copay per visit
Tests, labs, & imaging
$0-100 copay
$0-25 copay
$25-250 copay
$0-100 copay
$90 copay per visit (always covered)
$0-25 copay per visit (always covered)
Hospital Services
$275 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
$25-255 copay per visit
Skilled nursing facility
$0 per day for days 1 through 20
$188 per day for days 21 through 100
$188 per day for days 21 through 100
Preventive services
$0 copay
Ambulance
$290 copay
Therapy services
$20 copay
$20 copay
Mental health services
$25 copay
$25 copay
$25 copay
$25 copay
Opioid treatment services
Covered
Other services
20% coinsurance per item
20% coinsurance per item
$0 copay or 10-20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $10.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
| Generic | $20.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | $100.00 copay | ||
| Specialty Tier | 33% |
Part B Drugs
20% coinsurance
20% coinsurance
Extra Benefits
Hearing
$25 copay
$0 copay
$299-599 copay
Preventive Dental
$0 copay
$0 copay
$0 copay
$0 copay
Comprehensive dental
0% coinsurance
Not covered
0% coinsurance
Not covered
0% coinsurance
0% coinsurance
0% coinsurance
Vision
$0 copay
$0 copay
$0 copay
Not covered
Not covered
Not covered
Other benefits
Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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