Humana Gold Plus SNP-DE H1036-104A (HMO SNP)

Medicare Advantage Plan (Part C w/ RX)

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PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Humana
CMS Rating
Plan Type
HMO SNP
Annual Deductible
$325.00

What To Know About This Plan

  • This plan has health and drug coverage
  • This plan is available for 2015. see plan

Why We Like This Plan

  • has both Health and Drug Coverage
  • Primary care physician office visit copay of $0
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Plan Details

Costs and Other Important Information

Plan Year:
2013
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,400 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$16.50
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$0
Not Applicable
Specialist Office Visit
$0
Not Applicable
Outpatient Services
$0
Not Applicable
Emergency Care
$25 maximum per visit
Not Applicable
Ambulance Services
$25 maximum
Not Applicable
Kidney Disease and Conditions
$0
Not Applicable
Home Health Care
$0
Not Applicable
Durable Medical Equipment
$0
Not Applicable
Inpatient Hospital Care
$0
Not Applicable
Skilled Nursing Facility (SNF)
$0
Not Applicable
Inpatient Mental Health Care
$0
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$0 copay$0 copay$0 copay
Tier 2: Non-Preferred Generic$0 copay$0 copay$0 copay
Tier 3: Preferred Brand Name$45 copay$45 copay$45 copay
Tier 4: Non-Preferred Brand Name$95 copay$95 copay$95 copay
Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$0 copay$0 copay
Tier 2: Non-Preferred Generic$0 copay$0 copay$0 copay
Tier 3: Preferred Brand Name$135 copay$135 copay$125 copay
Tier 4: Non-Preferred Brand Name$285 copay$285 copay$275 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
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
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 SNP-DE H1036-104A (HMO SNP) for Florida

/
COHEN, SHELDON
9000 SW 137TH AVE
MIAMI, FL 33186
MEZEY, ROBERT
12600 SW 120TH ST
MIAMI, FL 33186
GENAO, ESTEBAN
13059 SW 112TH ST
MIAMI, FL 33186
ROJAS, ROMEO
12002 SW 128TH CT STE 204
MIAMI, FL 33186
JIMENEZ, MILTON
12002 SW 128TH CT STE 204
MIAMI, FL 33186
GOUGH-FIBKINS, SHAWN
9824 SW 133RD CT
MIAMI, FL 33186
RENE N MAYORGA M D P A
14261 SW 120TH ST
MIAMI, FL 33186
CEBALLOS, CESAR
7800 SW 87TH AVE
MIAMI, FL 33173
NUNEZ, LOURDES
12002 SW 128TH CT
MIAMI, FL 33186
HERRERA, MAURICIO
11801 SW 90TH ST
MIAMI, FL 33186
AREVALO, EDITH
12608 SW 88TH ST
MIAMI, FL 33186
CARR, NATALIE
12608 SW 88TH ST
MIAMI, FL 33186
GALICIA, EDGAR
10010 KENNERLY RD
SAINT LOUIS, MO 63128
VAZQUEZ, NELSON
13500 SW 88 ST
KENDALL, FL 33186
ESPINOSA, CARMEN
13550 SW 88TH STREET STE 280
MIAMI, FL 33186
PANDO, JARY
13001 SW 88TH ST
MIAMI, FL 33186
RIESCO, DOUGLAS
12936 SW 133RD TER
MIAMI, FL 33186
MARTINEZ-RAMOS, MARIA
9000 SW 137 AVE
MIAMI, FL 33186
ZAMBRANA, NOREEN
14687 SW 104TH ST
MIAMI, FL 33186
JACQUEMIN, THIERRY
10254 SW 128TH CT
MIAMI, FL 33186
HERNANDEZ, OSCAR
14221 SW 120TH ST
MIAMI, FL 33186
OTERO, HEATHER
13400 SW 120TH ST
MIAMI, FL 33186
ROCHER, MARAY
11981 SW 97TH TER
MIAMI, FL 33186
SCHNEIDER, JESSICA
12608 SW 88TH ST
MIAMI, FL 33186
FERRY, PAULINA
14291 SW 120TH ST
MIAMI, FL 33186
Details
SHELDON COHEN, M.D.
Phone Number
(305) 380-6773
Office Locations
9000 SW 137TH AVE
MIAMI, FL 33186
9000 SW 137TH AVE MIAMI FL, 33186

Community Q&A

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