PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Humana
CMS Rating
Plan Type
HMO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2013
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$4,900 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$10 maximum per visit
Not Applicable
Specialist Office Visit
$40 maximum per visit
Not Applicable
Outpatient Services
$225 maximum or 20% maximum per visit
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$200 maximum
Not Applicable
Kidney Disease and Conditions
20% maximum per visit
Not Applicable
Home Health Care
$0
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Inpatient Hospital Care
Days 1-8: $195 copay per day. Days 9-90: $0 copay per day
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-7: $0 copay per day. Days 8-20: $50 copay per day. Days 21-100: $100 copay per day
Not Applicable
Inpatient Mental Health Care
Days 1-7: $195 copay per day. Days 8-90: $0 copay per day
Not Applicable

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$4 copay$4 copay$0 copay
Tier 2: Non-Preferred Generic$10 copay$10 copay$0 copay
Tier 3: Preferred Brand Name$45 copay$45 copay$45 copay
Tier 4: Non-Preferred Brand Name$90 copay$90 copay$90 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$12 copay$12 copay$0 copay
Tier 2: Non-Preferred Generic$30 copay$30 copay$0 copay
Tier 3: Preferred Brand Name$135 copay$135 copay$125 copay
Tier 4: Non-Preferred Brand Name$270 copay$270 copay$260 copay
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Not Rated
Monitoring physical ability
Not Rated
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability

Physician Finder

Physicians that accept Humana Gold Plus H2012-007 (HMO) for South Carolina

/
DAVIES, BRYAN
9600 TWO NOTCH RD
COLUMBIA, SC 29223
GROSS, JEFFREY
7620 TRENHOLM ROAD EXT
COLUMBIA, SC 29223
FISHBURNE, BARRON
7620 TRENHOLM ROAD EXT
COLUMBIA, SC 29223
MAGEE, MICHAEL
7620 TRENHOLM ROAD EXT
COLUMBIA, SC 29223
BOULWARE, RALEIGH
7 MEDICAL PARK
COLUMBIA, SC 29223
TRUESDALE, DIANE
7 MEDICAL PARK
COLUMBIA, SC 29223
DEAL, ROGER
125 ALPINE CIRCLE
COLUMBIA, SC 29223
BRANDENBURG, JEFFERY
125 ALPINE CIR
COLUMBIA, SC 29223
CLAYTOR, JAMES
125 ALPINE CIRCLE
COLUMBIA, SC 29223
MOHIUDDIN, AZIZ
125 ALPINE CIRCLE
COLUMBIA, SC 29223
MOZINGO, ELLIE
125 ALPINE CIRCLE
COLUMBIA, SC 29223
WALKUP, WILLIAM
125 ALPINE CIRCLE
COLUMBIA, SC 29223
HAMRICK, DALE
124 SPRING VALLEY CT
COLUMBIA, SC 29223
JUVEKAR, MADHURI
4214 HARD SCRABBLE RD
COLUMBIA, SC 29223
CHISHOM, MARK
9310 TWO NOTCH ROAD
COLUMBIA, SC 29223
BAGGETT, TERESA
74 POLO RD
COLUMBIA, SC 29223
SMITH, DAVID
76 POLO RD
COLUMBIA, SC 29223
COSBY, JOHN
7346 PARKLANE RD
COLUMBIA, SC 29223
STEELE, JOHN
125 ALPINE CIR
COLUMBIA, SC 29223
FADEL, SHERRY
9600 TWO NOTCH RD
COLUMBIA, SC 29223
STEEN, RONALD
120 IRONGATE DR
COLUMBIA, SC 29223
ELKINS, ANTHONY
1070 WILDEWOOD CENTR DRIVE
COLUMBIA, SC 29229
HUTT, JOHN
741 FASHION DR
COLUMBIA, SC 29229
CARSON, LEE
220 GRACES WAY
COLUMBIA, SC 29229
HICKS-SNODDY, LYNN
100 SUMMIT CENTRE DR
COLUMBIA, SC 29229
Details
BRYAN DAVIES, DPM
Phone Number
(803) 788-5916
Office Locations
9600 TWO NOTCH RD
COLUMBIA, SC 29223
9600 TWO NOTCH RD COLUMBIA SC, 29223

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.

Similar Plans

PremiumPlan NameCMS Rating
$0.00
Humana Gold Choice H8145-115 (PFFS)
Select
$15.00
AARP MedicareRx Saver Plus (PDP)
Select
$0.00
Patriot (PFFS)
Select
$29.10
SilverScript Choice (PDP)
Select
$33.90
First Health Part D Value Plus (PDP)
Select

Related Articles

Related Searches