If you’re a Humana member, your copays could be lower through Humana Pharmacy. Each order is double checked by 2 pharmacists for accuracy, and you’ll receive your medications at the location of your choice in plain packaging for your privacy. Quick and easy refills. Humana Behavioral Health Services Include: Providing access to a participating behavioral health network that includes individual providers, hospitals, and mental and substance abuse programs. To find a Humana Behavioral Health provider near you, use our online Provider Lookup (link opens in.

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Humana Gold Plus H4461-036 (HMO-POS) H4461-036 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Humana available to residents in Tennessee. This plan includes additional Medicare prescription drug (Part-D) coverage. The Humana Gold Plus H4461-036 (HMO-POS) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $5,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,900 out of pocket. This can be a extremely nice safety net.

Humana Gold Plus H4461-036 (HMO-POS) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Gold Plus H4461-036 (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST

2021 Humana Medicare Advantage Plan Costs

Name:
Plan ID:	H4461-036
Provider:	Humana
Year:	2021
Type:	Local HMO
Monthly Premium C+D:	$0
Part C Premium:	$0
MOOP:	$5,900
Part D (Drug) Premium:	$0
Part D Supplemental Premium	$0
Total Part D Premium:	$0
Drug Deductible:	$0
Tiers with No Deductible:	0
Gap Coverage:	No
Benchmark:	not below the regional benchmark
Type of Medicare Health:	Enhanced Alternative
Drug Benefit Type:	Enhanced
Similar Plan:	H4461-037

Humana Gold Plus H4461-036 (HMO-POS) Part-C Premium

Backup folder for iphone in mac. Humana plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H4461-036 Part-D Deductible and Premium

Humana Gold Plus H4461-036 (HMO-POS) has a monthly drug premium of $0 and a $0 drug deductible. This Humana plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Humana above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Humana Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Humana plan does not offer additional coverage through the gap.

H4461-036 Formulary or Drug Coverage

Humana Gold Plus H4461-036 (HMO-POS) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

2021 Humana Gold Plus H4461-036 (HMO-POS) Summary of Benefits

Additional Benefits

No

Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	55% coinsurance (Out-of-Network)
Extractions	0% coinsurance
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	55% coinsurance (Out-of-Network)
Restorative services	0% coinsurance

Deductible

$0

Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$35-295 copay
Diagnostic tests and procedures	$0-100 copay
Lab services	$0-35 copay
Outpatient x-rays	$0-35 copay

Doctor Visits

Primary	$0 copay
Specialist	$35 copay per visit

Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$0-35 copay per visit (always covered)

Foot Care (podiatry services)

Foot exams and treatment	$35 copay
Routine foot care	Not covered

Ground Ambulance

$290 copay

Hearing

Fitting/evaluation	$0 copay
Hearing aids	$399-699 copay
Hearing exam	$35 copay

Inpatient Hospital Coverage

Not Applicable (Out-of-Network)
$295 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 91 and beyond

Medical Equipment/Supplies

Diabetes supplies	$0 copay or 10-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

Medicare Part B Drugs

Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance

Mental Health Services

Inpatient hospital - psychiatric	Not Applicable (Out-of-Network)
Inpatient hospital - psychiatric	$295 per day for days 1 through 6 $0 per day for days 7 through 90
Outpatient group therapy visit	$35 copay
Outpatient group therapy visit with a psychiatrist	$35 copay
Outpatient individual therapy visit	$35 copay
Outpatient individual therapy visit with a psychiatrist	$35 copay

MOOP

$5,900 In-network

Option

No

Optional supplemental benefits

No

Outpatient Hospital Coverage

$35-295 copay per visit

Preventive Care

$0 copay

Preventive Dental

Cleaning	$0 copay
Cleaning	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Fluoride treatment	Not covered
Oral exam	$0 copay (Out-of-Network)
Oral exam	$0 copay

Humana Copay Tiers

Rehabilitation Services

Occupational therapy visit	$25 copay
Physical therapy and speech and language therapy visit	$25 copay

Skilled Nursing Facility

Not Applicable (Out-of-Network)
$0 per day for days 1 through 20 $184 per day for days 21 through 100

Transportation

Not covered

Vision

Contact lenses	$0 copay
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$0 copay
Upgrades	Not covered

Wellness Programs (e.g. fitness nursing hotline)

Covered

Reviews for Humana Gold Plus H4461-036 (HMO-POS) H4461

2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Humana Gold Plus H4461-036 (HMO-POS) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for Humana Gold Plus H4461-036 (HMO-POS)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Humana Gold Plus H4461-036 (HMO-POS) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST

Coverage Area for Humana Gold Plus H4461-036 (HMO-POS)

(Click county to compare all available Advantage plans)

State:	Tennessee
County:	Bledsoe,Bradley,Franklin,Grundy,Hamilton, Marion,McMinn,Meigs,Polk, Rhea,Sequatchie,

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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HumanaChoice H5216-214 (PPO) H5216-214 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Humana available to residents in Alabama. This plan includes additional Medicare prescription drug (Part-D) coverage. The HumanaChoice H5216-214 (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out of pocket. This can be a extremely nice safety net.

HumanaChoice H5216-214 (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. Pioneer ddj t1 driver for mac. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for HumanaChoice H5216-214 (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST

2021 Humana Medicare Advantage Plan Costs

Name:
Plan ID:	H5216-214
Provider:	Humana
Year:	2021
Type:	Local PPO
Monthly Premium C+D:	$0
Part C Premium:	$0
MOOP:	$6,700
Part D (Drug) Premium:	$22.00
Part D Supplemental Premium	$0
Total Part D Premium:	$22.00
Drug Deductible:	$150.0
Tiers with No Deductible:	1
Gap Coverage:	No
Benchmark:	not below the regional benchmark
Type of Medicare Health:	Enhanced Alternative
Drug Benefit Type:	Enhanced
Similar Plan:	H5216-215

HumanaChoice H5216-214 (PPO) Part-C Premium

Humana plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H5216-214 Part-D Deductible and Premium

HumanaChoice H5216-214 (PPO) has a monthly drug premium of $22.00 and a $150.0 drug deductible. This Humana plan offers a $22.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Humana above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $22.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Humana Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Humana plan does not offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The HumanaChoice H5216-214 (PPO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $5.50 for 75% low income subsidy $11.00 for 50% and $16.50 for 25%.

Full LIS Premium:	$0
75% LIS Premium:	$5.50
50% LIS Premium:	$11.00
25% LIS Premium:	$16.50

H5216-214 Formulary or Drug Coverage

HumanaChoice H5216-214 (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

2021 HumanaChoice H5216-214 (PPO) Summary of Benefits

Additional Benefits

No

Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	50% coinsurance
Restorative services	55% coinsurance (Out-of-Network)

Deductible

$1,000 annual deductible

Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	40% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$40-225 copay
Diagnostic tests and procedures	$0 copay or 40% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0-100 copay
Lab services	40% coinsurance (Out-of-Network)
Lab services	$0-40 copay
Outpatient x-rays	40% coinsurance (Out-of-Network)
Outpatient x-rays	$10-50 copay

Doctor Visits

Primary	$10 copay per visit
Primary	40% coinsurance per visit (Out-of-Network)
Specialist	40% coinsurance per visit (Out-of-Network)
Specialist	$40 copay per visit

Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$10-40 copay or 40% coinsurance per visit (always covered)

Foot Care (podiatry services)

Foot exams and treatment	$40 copay
Foot exams and treatment	40% coinsurance (Out-of-Network)
Routine foot care	Not covered

Ground Ambulance

$290 copay
$290 copay (Out-of-Network)

Hearing

Fitting/evaluation	Not covered
Hearing aids - inner ear	Not covered
Hearing aids - outer ear	Not covered
Hearing aids - over the ear	Not covered
Hearing exam	$40 copay
Hearing exam	40% coinsurance (Out-of-Network)

Inpatient Hospital Coverage

$260 per day for days 1 through 7 $0 per day for days 8 through 90 $0 per day for days 91 and beyond
40% per stay (Out-of-Network)

Medical Equipment/Supplies

Diabetes supplies	$0 copay or 10-20% coinsurance per item
Diabetes supplies	20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	25% coinsurance per item (Out-of-Network)

Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	20-40% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	20-40% coinsurance (Out-of-Network)

Mental Health Services

Inpatient hospital - psychiatric	40% per stay (Out-of-Network)
Inpatient hospital - psychiatric	$260 per day for days 1 through 6 $0 per day for days 7 through 90
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	40% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	40% coinsurance (Out-of-Network)
Outpatient individual therapy visit	40% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	40% coinsurance (Out-of-Network)

MOOP

$10,000 In and Out-of-network $6,700 In-network

Humana Copay Plans

Option

No

Optional supplemental benefits

Yes

Outpatient Hospital Coverage

40% coinsurance per visit (Out-of-Network)
$40-250 copay per visit

Package #1

Deductible
Monthly Premium	$17.20

Preventive Care

$0 copay
$0 copay or 40% coinsurance (Out-of-Network)

Preventive Dental

Cleaning	$0 copay
Cleaning	50% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Dental x-ray(s)	50% coinsurance (Out-of-Network)
Fluoride treatment	Not covered
Oral exam	50% coinsurance (Out-of-Network)
Oral exam	$0 copay

Rehabilitation Services

Occupational therapy visit	$20 copay
Occupational therapy visit	40% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	40% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$20 copay

Skilled Nursing Facility

40% per stay (Out-of-Network)
$0 per day for days 1 through 20 $184 per day for days 21 through 100

Transportation

Not covered

Vision

Contact lenses	Not covered
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	$0 copay (Out-of-Network)
Upgrades	Not covered

Wellness Programs (e.g. fitness nursing hotline)

Covered

Reviews for HumanaChoice H5216-214 (PPO) H5216

2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in HumanaChoice H5216-214 (PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for HumanaChoice H5216-214 (PPO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

HumanaChoice H5216-214 (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

Ready to Enroll?

Humana Copay Amounts

Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST

Humana Copay Prescriptions

Coverage Area for HumanaChoice H5216-214 (PPO)

(Click county to compare all available Advantage plans)

State:	Alabama
County:	Colbert,DeKalb,Franklin,Jackson,Lauderdale, Lawrence,Limestone,Madison,Marion, Marshall,Morgan,Winston,Autauga, Bibb,Blount,Bullock,Butler, Calhoun,Cherokee,Chilton,Cleburne, Cullman,Dallas,Elmore,Etowah, Fayette,Greene,Hale,Jefferson, Lamar,Lowndes,Macon,Montgomery, Perry,Pickens,Pike,Shelby, St Clair,Sumter,Talladega,Tuscaloosa, Walker,Choctaw,Conecuh,Marengo, Monroe,Washington,Wilcox,

Humana Copay For Ultrasound

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.