Humana Gold Choice H8145-055 (PFFS)


Medicare Plan Details

2022 Plan
Monthly Premium
(select county for price)

 

by Humana
Additional Coverage
Hearing
Overall Government Star Rating
 4.0
out of 5 stars

State: West Virginia

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

 

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

Medical Benefits

Doctor Services

In-network: $15 copay per visit
Out-of-network: $15-45 copay per visit
In-network: $45 copay per visit
Out-of-network: $45 copay per visit

Tests, labs, & imaging

In-network: $0-105 copay
Out-of-network: $0-105 copay
In-network: $0-40 copay
Out-of-network: $0-105 copay
In-network: $45-390 copay
Out-of-network: $45-390 copay
In-network: $15-100 copay
Out-of-network: $15-100 copay
$90 copay per visit (always covered)
$15-45 copay per visit (always covered)

Hospital Services

In-network: $390 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: $390 per day for days 1 through 5
$0 per day for days 6 through 90
In-network: $45-390 copay per visit
Out-of-network: $45-390 copay 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: $0 per day for days 1 through 20
$178 per day for days 21 through 100

Preventive services

In-network: $0 copay
Out-of-network: $0 copay

Ambulance

In-network: $270 copay
Out-of-network: $270 copay

Therapy services

In-network: $20-40 copay
Out-of-network: $20-40 copay
In-network: $20-40 copay
Out-of-network: $20-40 copay

Mental health services

In-network: $40 copay
Out-of-network: $45 copay
In-network: $40 copay
Out-of-network: $45 copay
In-network: $40 copay
Out-of-network: $45 copay
In-network: $40 copay
Out-of-network: $45 copay

Opioid treatment services

Covered

Other services

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

Extra Benefits

Hearing

In-network: $45 copay
Out-of-network: $45 copay
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

Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
 4
 3
 3
 4
 4
 5

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