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?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$6,700 In-Network
Other Deductibles?
In Network: Yes. 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
$20 maximum per visit
Not Applicable
Outpatient Services
$100 maximum or 20% maximum per visit
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$150 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 1-5: $50 copay per day. Days 6-90: $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 1-5: $50 copay per day. Days 6-90: $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$3 copay$3 copay$0 copay
Tier 2: Non-Preferred Generic$6 copay$6 copay$0 copay
Tier 3: Preferred Brand Name$35 copay$35 copay$35 copay
Tier 4: Non-Preferred Brand Name$80 copay$80 copay$80 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$9 copay$9 copay$0 copay
Tier 2: Non-Preferred Generic$18 copay$18 copay$0 copay
Tier 3: Preferred Brand Name$105 copay$105 copay$95 copay
Tier 4: Non-Preferred Brand Name$240 copay$240 copay$230 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 Total Care Advantage (HMO) for Louisiana

/
SMITH, CHRISTINE
11548 OLD HAMMOND HWY
BATON ROUGE, LA 70816
BALDRIDGE, LISA
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
KHALID-ABASI, MUNIR
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
SUICO, MELIVA
11281 OLD HAMMOND HWY
BATON ROUGE, LA 70816
SUICO, VALERIANO
11281 OLD HAMMOND HWY
BATON ROUGE, LA 70816
IDOWU, BENEDICT
17050 MEDICAL CENTER DR
BATON ROUGE, LA 70816
WAHID, SAIYID
1962 ONEAL LN
BATON ROUGE, LA 70816
HERNANDEZ, LINCOLN
60 GRAMERCY PARK N
NEW YORK, NY 10010
FERGUSON, DANIEL
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
STEVENS, KASAN
11918 SUNRAY AVE
BATON ROUGE, LA 70816
ELLIOTT, MARY
17050 MEDICAL CENTER DR STE 400
BATON ROUGE, LA 70816
NGUYEN, SI
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
WILTON, TERRI
11140 N HARRELLS FERRY RD
BATON ROUGE, LA 70816
KRAMM, PAUL
2645 ONEAL LN
BATON ROUGE, LA 70816
BULLER, MYRA
2645 ONEAL LN BLDG C SUITE D
BATON ROUGE, LA 70816
JOHNSTON, FRANCIS
1940 ONEAL LN
BATON ROUGE, LA 70816
DUCOTE, SUSAN
11140 N HARRELLS FERRY RD
BATON ROUGE, LA 70816
BARNETT, BRIAN
17050 MEDICAL CENTER DRIVE
BATON ROUGE, LA 70816
DOMINICK, KIMBERLY
5536 SUPERIOR DR STE C
BATON ROUGE, LA 70816
GIANOLI, GERARD
17050 MEDICAL CENTER DR
BATON ROUGE, LA 70816
MORVANT, KRISTIN
16777 MEDICAL CENTER
BATON ROUGE, LA 70816
HARRIS, ANGELA
16777 MEDICAL CENTER DRIVE
BATON ROUGE, LA 70816
FABRE, JARED
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
STAFFORD, ANGELA
15420 S HARRELLS FERRY RD
BATON ROUGE, LA 70816
CHAPMAN, KAYLA
11140 N. HARRELLS FERRY ROAD
BATON ROUGE, LA 70816
Details
CHRISTINE SMITH, MD
Phone Number
(225) 275-4656
Office Locations
11548 OLD HAMMOND HWY
BATON ROUGE, LA 70816
11548 OLD HAMMOND HWY BATON ROUGE LA, 70816

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