PARTC

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C)
Insurance Provider
Humana
CMS Rating
Plan Type
PFFS
Annual Deductible
$0.00

What To Know About This Plan

  • This is a health coverage only plan with no drug coverage

Why We Like This Plan

  • has no additional premium costs outside of your Medicare Part B premium

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Monthly Drug Plan Premium
Not Applicable
Health Plan Deductible
$500 Out-of-network
Choice of Doctors?
Plan Doctors for Most Services
Monthly Health Plan Premium
$0.00
Out-Of-Pocket Spending Limit
$6,700 In and Out-of-network
Optional Supplemental Benefits?
Yes
Prescription Drugs Covered?
No
Other Health Plan Deductibles?
Yes

Benefits

Service
Cost
Ambulance Services
  • In-network: 20% of the cost

  • Out-of-network: 20% of the cost
  • Doctors Office Visits
    Primary care physician visit:
  • In-network: $15 copay

  • Out-of-network: 35% of the cost

  • Specialist visit:
  • In-network: $15-40 copay, depending on the service

  • Out-of-network: 35% of the cost

  • For Coumadin services received at an in-network specialist's office,
    you pay: $15 copayment and 35% coinsurance at an out-of-network
    specialist's office
    Emergency Care
    $75 copay
    Home Health Care
  • In-network: You pay nothing

  • Out-of-network: 35% of the cost
  • Mental Health Care
    Inpatient visit:
    Our plan covers up to 190 days in a lifetime for inpatient mental
    health care in a psychiatric hospital. The inpatient hospital care limit
    does not apply to inpatient mental services provided in a general
    hospital.
    Our plan covers 90 days for an inpatient hospital stay.
    Our plan also covers 60 "lifetime reserve days." These are "extra" days
    that we cover. If your hospital stay is longer than 90 days, you can
    use these extra days. But once you have used up these extra 60 days,
    your inpatient hospital coverage will be limited to 90 days.
  • In-network:

  • $250 copay per day for days 1 through 6

  • You pay nothing per day for days 7 through 90

  • Out-of-network:

  • 35% of the cost per stay

  • Outpatient group therapy visit:
  • In-network: $40 copay

  • Out-of-network: 35% of the cost

  • Outpatient individual therapy visit:
  • In-network: $40 copay

  • Out-of-network: 35% of the cost

  • You pay this amount each time you are admitted or transferred to a
    facility.
    Outpatient hospital
    In-network: 25% per visit
    Out-of-network: 35% per visit
    Renal dialysis
    In-network: 20% per visit
    Out-of-network: 20% per visit
    Inpatient Hospital Care
    In-network: $250 for days 1 through 7
    $0 for days 8 through 90
    $0 for days 91 and beyond
    Out-of-network: 35% per stay
    Acupuncture
    Not covered
    Chiropractic Care
    Manipulation of the spine to correct a subluxation (when 1 or more of
    the bones of your spine move out of position):
  • In-network: $20 copay

  • Out-of-network: 35% of the cost
  • Dental Services
    Limited dental services (this does not include services in connection
    with care, treatment, filling, removal, or replacement of teeth):
  • In-network: $40 copay

  • Out-of-network: 35% of the cost
  • Diabetes Supplies and Services
    Diabetes monitoring supplies:
  • In-network: 0-20% of the cost, depending on the supply

  • Out-of-network: 20% of the cost

  • Diabetes self-management training:
  • In-network: You pay nothing

  • Out-of-network: 35% of the cost

  • Therapeutic shoes or inserts:
  • In-network: $10 copay

  • Out-of-network: 20% of the cost
  • Diagnostic Tests, Lab and Radiology Services, and X-Rays (Costs for these services may be different if received in an outpatient surgery setting)
    Diagnostic radiology services (such as MRIs, CT scans):
  • In-network: $40-200 copay or 20-25% of the cost, depending on

  • the service
  • Out-of-network: 35% of the cost

  • Diagnostic tests and procedures:
  • In-network: $0-40 copay or 25% of the cost, depending on the

  • service
  • Out-of-network: 35% of the cost

  • Lab services:
  • In-network: $0-40 copay or 25% of the cost, depending on the

  • service
  • Out-of-network: 35% of the cost

  • Outpatient x-rays:
  • In-network: $15-40 copay or 20-25% of the cost, depending on

  • the service
  • Out-of-network: 35% of the cost

  • Therapeutic radiology services (such as radiation treatment for
    cancer):
  • In-network: $40 copay or 20% of the cost, depending on the

  • service
  • Out-of-network: 35% of the cost

  • The copay depends on where the service is provided.
    Please call Customer Care for further details.
    Hearing Services
    Exam to diagnose and treat hearing and balance issues:
  • In-network: $40 copay

  • Out-of-network: 35% of the cost
  • Outpatient Rehabilitation
    Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions
    per day for up to 36 sessions up to 36 weeks):
  • In-network: $15 copay or 25% of the cost, depending on the

  • service
  • Out-of-network: 35% of the cost

  • Occupational therapy visit:
  • In-network: $15 copay or 25% of the cost, depending on the

  • service
  • Out-of-network: 35% of the cost

  • Physical therapy and speech and language therapy visit:
  • In-network: $15 copay or 25% of the cost, depending on the

  • service
  • Out-of-network: 35% of the cost

  • In-Network

  • Cardiac Therapy Rehabilitation

  • – Specialist: $15 copayment
    – Outpatient: 25% coinsurance
  • Occupational, Physical, Speech Therapy

  • – Specialist: $15 copayment
    – Outpatient: 25% coinsurance
    – Comprehensive Outpatient Rehab: $15 copayment
    Outpatient Substance Abuse
    Group therapy visit:
  • In-network: $40 copay or 20-25% of the cost, depending on the

  • service
  • Out-of-network: 35% of the cost

  • Individual therapy visit:
  • In-network: $40 copay or 20-25% of the cost, depending on the

  • service
  • Out-of-network: 35% of the cost

  • In-Network:

  • 25% coinsurance Outpatient hospital

  • 20% coinsurance Partial hospitalization

  • $40 copayment Specialist's Office

  • Out-of-Network:

  • 35% coinsurance Outpatient hospital

  • 35% coinsurance Partial hospitalization

  • 35% coinsurance Specialist's Office
  • Outpatient Surgery
    Ambulatory surgical center:
  • In-network: 20% of the cost

  • Out-of-network: 35% of the cost

  • Outpatient hospital:
  • In-network: 25% of the cost

  • Out-of-network: 35% of the cost
  • Over-the-Counter Items
    Please visit our website to see our list of covered over-the-counter
    items.
    – You are eligible to receive a $10 monthly benefit toward the
    purchase of selected over-the-counter items when you use
    Humana's mail order service.
    – For more information or to request an order form, please call
    Customer Care.
    Renal Dialysis
  • In-network: 20% of the cost

  • Out-of-network: 20% of the cost
  • Transportation
    Not covered
    Vision Services
    Exam to diagnose and treat diseases and conditions of the eye
    (including yearly glaucoma screening):
  • In-network: $0-40 copay, depending on the service

  • Out-of-network: 35% of the cost

  • Routine eye exam:
  • In-network: $0 copay. You are covered for up to 1 every year.

  • Out-of-network: $0 copay. There may be a limit to how often

  • these services are covered.
    Our plan pays up to $40 every year for routine eye exams from any
    provider.
    Eyeglasses or contact lenses after cataract surgery:
  • In-network: You pay nothing

  • Out-of-network: 35% of the cost
  • Preventive Care
  • In-network: You pay nothing

  • Out-of-network: 0-35% of the cost, depending on the service

  • Our plan covers many preventive services, including:
  • Abdominal aortic aneurysm screening

  • Alcohol misuse counseling

  • Bone mass measurement

  • Breast cancer screening (mammogram)

  • Cardiovascular disease (behavioral therapy)

  • Cardiovascular screenings

  • Cervical and vaginal cancer screening

  • Colorectal cancer screenings (Colonoscopy, Fecal occult blood

  • test, Flexible sigmoidoscopy)
  • Depression screening

  • Diabetes screenings

  • HIV screening

  • Medical nutrition therapy services

  • Obesity screening and counseling

  • Prostate cancer screenings (PSA)

  • Sexually transmitted infections screening and counseling

  • Tobacco use cessation counseling (counseling for people with

  • no sign of tobacco-related disease)
  • Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal

  • shots
  • "Welcome to Medicare" preventive visit (one-time)

  • Yearly "Wellness" visit

  • Any additional preventive services approved by Medicare during the
    contract year will be covered.
    Hospice
    You pay nothing for hospice care from a Medicare-certified hospice.
    You may have to pay part of the costs for drugs and respite care.
    Hospice is covered outside of our plan. Please contact us for more
    details.
    INPATIENT CARE Inpatient Hospital Care
    Our plan covers an unlimited number of days for an inpatient hospital
    stay.
  • In-network:

  • $250 copay per day for days 1 through 7

  • You pay nothing per day for days 8 through 90

  • You pay nothing per day for days 91 and beyond

  • Out-of-network:

  • 35% of the cost per stay

  • You pay this amount each time you are admitted or transferred to a
    facility.
    Durable Medical Equipment
  • In-network: 20% of the cost

  • Out-of-network: 20% of the cost

  • If you go to a preferred vendor, your cost may be less. Contact us for a
    list of preferred vendors.
    Foot Care
    Foot exams and treatment if you have diabetes-related nerve
    damage and/or meet certain conditions:
  • In-network: $40 copay

  • Out-of-network: 35% of the cost
  • Urgent Care
    $15-40 copay or 35% of the cost (up to $65), depending on the
    service
  • In-network:

  • $15 copayment Primary care

  • $40 copayment Specialist's office

  • $40 copayment urgent care center

  • Out-of-Network:

  • 35% coinsurance Primary care

  • 35% coinsurance Specialist's office

  • 35% coinsurance urgent care center
  • Skilled Nursing Facility
    Our plan covers up to 100 days in a SNF.
  • In-network:

  • You pay nothing per day for days 1 through 20

  • $50 copay per day for days 21 through 100

  • Out-of-network:

  • 35% of the cost per stay
  • Prosthetic Devices
    Prosthetic devices:
  • In-network: 20% of the cost

  • Out-of-network: 20% of the cost

  • Related medical supplies:
  • In-network: 20% of the cost

  • Out-of-network: 20% of the cost
  • CMS Ratings

    Staying healthy - screenings, tests and vaccines

    Breast cancer screening
    Colorectal cancer screening
    Annual flu vaccine
    Improving or maintaining physical health
    Improving or maintaining mental health
    Monitoring physical ability
    Adult BMI assessment

    Managing Chronic Conditions

    Special needs plan care management
    Not Rated
    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
    Controlling blood pressure
    Rheumatoid arthritis management
    Reducing the risk of falling
    Plan all-cause readmissions

    Member Experience with Health Plan

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

    Member Complaints, and Changes in Health Plan's Performance

    Complaints about the health plan
    Members choosing to leave the health plan
    Beneficiary access and performance problems
    Health plan quality improvement

    Health Plan Customer Service

    Plan makes timely decision about appeals
    Reviewing appeals decisions
    Call center – foreign language interpreter and TTY/TDD availability - Medical

    Drug Plan Customer Service

    Call center – foreign language interpreter and TTY/TDD availability - Drugs
    Appeals auto-forward
    Appeals upheld

    Member Complaints, and Changes in Drug Plan's Performance

    Complaints about the drug plan
    Members choosing to leave the drug plan
    Beneficiary access and performance problems
    Drug plan quality improvement

    Member Experience with Drug Plan

    Rating of drug plan
    Getting needed prescription drugs

    Drug Pricing and Patient Safety

    MPF Price Accuracy
    High risk medication
    Part D medication adherence for diabetes
    Part D medication adherence for hypertension
    Part D medication adherence for cholesterol
    Medication Therapy Management program completion rate

    Physician Finder

    Physicians that accept Humana Gold Choice H8145-108 (PFFS) for Virginia

    /
    KALAGAYAN, HECTOR
    5486 INDIAN RIVER RD
    VIRGINIA BEACH, VA 23464
    BARRERA, JANICE
    5301 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    MCVICKER, ALEXANDRA
    5301 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    MORRISON, SANFORD
    904 KEMPSVILLE RD STE 102
    VIRGINIA BEACH, VA 23464
    WATSON, BETYSHIA
    5320 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    MACDONALD, BERNADETTE
    1400 FORDHAM DR
    VIRGINIA BEACH, VA 23464
    TAYLOR, RUTH
    5301 PROVIDENCE RD STE 80
    VIRGINIA BEACH, VA 23464
    HANKINS, LAUREN
    5301 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    JORDE, JESSICA
    5301 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    HODGES, CRYSTAL
    5301 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    PEARL, DINA
    6095 INDIAN RIVER RD
    VIRGINIA BEACH, VA 23464
    SINESI, CHRISTOPHER
    6477 COLLEGE PARK SQ
    VIRGINIA BEACH, VA 23464
    PLANCHAK, ALLISON
    5301 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    KING, AMY
    5301 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    BHATTI, PARVEEN
    6095 INDIAN RIVER RD.
    VIRGINIA BEACH, VA 23464
    MAHONEY, ROBERT
    5320 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    RILES, NATHAN
    6632 INDIAN RIVER RD
    VIRGINIA BEACH, VA 23464
    KLIMAZ, TRACY
    5253 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    ROMERO, CYNTHIA
    6009 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    EDMONDS, BEATRIX
    5249 PROVIDENCE ROAD
    VIRGINIA BEACH, VA 23464
    MENON, PADMAN
    5249 PROVIDENCE ROAD
    VIRGINIA BEACH, VA 23464
    JAVIER, FRANCIS
    5320 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    FELDMAN, HOWARD
    1212 LAKE JAMES DR
    VIRGINIA BEACH, VA 23464
    SPADA, PAUL
    533 RODNEY LN
    VIRGINIA BEACH, VA 23464
    SULLIVAN, KAREN
    5320 PROVIDENCE RD
    VIRGINIA BEACH, VA 23464
    Details
    HECTOR KALAGAYAN, M.D.
    Phone Number
    (757) 424-2490
    Office Locations
    5486 INDIAN RIVER RD
    VIRGINIA BEACH, VA 23464
    5486 INDIAN RIVER RD VIRGINIA BEACH VA, 23464

    Similar Plans

    PremiumPlan NameCMS Rating
    from $39
    Kaiser Permanente Medicare Plus Std w/Part D (B) (Cost)
    Details
    from $27
    SilverScript Choice (PDP)
    Details
    from $18
    Humana Walmart Rx Plan (PDP)
    Details
    from $0
    Anthem MediBlue Local (HMO)
    Details
    from $0
    AARP MedicareComplete Plan 1 (HMO)
    Details

    Related Articles

    Related Searches

    {}