PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Humana
CMS Rating
Plan Type
HMO
Annual Deductible
$360.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium
  • was the 3rd best selling plan in Brown in 2014

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors for Most Services
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$6,700 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Ambulance Services
$300 copay
Doctors Office Visits
Primary care physician visit: $15 copay
Specialist visit: $50 copay
Emergency Care
$75 copay
If you are admitted to the hospital within 24 hours, you do not have
to pay your share of the cost for emergency care. See the "Inpatient
Hospital Care" section of this booklet for other costs.
Home Health Care
You pay nothing
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.
  • $260 copay per day for days 1 through 6

  • You pay nothing per day for days 7 through 90

  • Outpatient group therapy visit: $40 copay
    Outpatient individual therapy visit: $40 copay
    You pay this amount each time you are admitted or transferred to a
    facility.
    Outpatient hospital
    $295 per visit
    Renal dialysis
    20% per visit
    Inpatient Hospital Care
    $295 for days 1 through 6
    $0 for days 7 through 90
    $0 for days 91 and beyond
    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): $20 copay
    Dental Services
    Limited dental services (this does not include services in connection
    with care, treatment, filling, removal, or replacement of teeth): $50
    copay
    Preventive dental services:
    Cleaning (for up to 1 every year): You pay nothing
    Dental x-ray(s) (for up to 1 every year): You pay nothing
    Oral exam (for up to 1 every year): You pay nothing
    Additional benefits are covered by your plan. For detailed benefit
    information please call the Customer Care number listed in the
    “Things To Know About Your Plan” section above.
    Diabetes Supplies and Services
    Diabetes monitoring supplies: 0-20% of the cost, depending on the
    supply
    Diabetes self-management training: You pay nothing
    Therapeutic shoes or inserts: You pay nothing
    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): $15-295
    copay, depending on the service
    Diagnostic tests and procedures: $0-100 copay, depending on the
    service
    Lab services: $0-50 copay, depending on the service
    Outpatient x-rays: $15-100 copay, depending on the service
    Therapeutic radiology services (such as radiation treatment for
    cancer): 20% 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: $50 copay
    Routine hearing exam (for up to 1 every year): You pay nothing
    Hearing aid fitting/evaluation (for up to 1 every year): You pay
    nothing
    Hearing aid: $0 copay
    Our plan pays up to $1,000 every three years for hearing aids.
    You pay nothing up to the $1000 allowance every three years.
    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): $15 copay
    Occupational therapy visit: $40 copay
    Physical therapy and speech and language therapy visit: $40 copay
  • Cardiac Therapy Rehabilitation

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

  • – Specialist: $40 copayment
    – Outpatient: $40 copayment
    – Comprehensive Outpatient Rehab: $40 copayment
    Outpatient Substance Abuse
    Group therapy visit: $40-100 copay, depending on the service
    Individual therapy visit: $40-100 copay, depending on the service
    You pay:
    – $55 copayment at a hospital facility for partial hospitalization
    – $100 copayment at a hospital facility as an outpatient
    – $40 copayment at a specialist's office.
    Outpatient Surgery
    Ambulatory surgical center: $245 copay
    Outpatient hospital: $295 copay
    Over-the-Counter Items
    Please visit our website to see our list of covered over-the-counter
    items.
    – You are eligible to receive a $15 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
    20% of the cost
    Transportation
    Not covered
    Vision Services
    Exam to diagnose and treat diseases and conditions of the eye
    (including yearly glaucoma screening): $0-50 copay, depending on
    the service
    Routine eye exam (for up to 1 every year): You pay nothing
    Eyeglasses or contact lenses after cataract surgery: You pay nothing
    Preventive Care
    You pay nothing
    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.
  • $295 copay per day for days 1 through 6

  • You pay nothing per day for days 7 through 90

  • You pay nothing per day for days 91 and beyond

  • You pay this amount each time you are admitted or transferred to a
    facility.
    Durable Medical Equipment
    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: $50 copay
    Urgent Care
    $15-50 copay, depending on the service
    For each Medicare-covered urgently needed care visit, you pay:
    – $15 copayment at your primary care doctor's office
    – $50 copayment at a specialist's office
    – $25 copayment at an urgent care center
    Skilled Nursing Facility
    Our plan covers up to 100 days in a SNF.
  • You pay nothing per day for days 1 through 20

  • $160 copay per day for days 21 through 100
  • Prosthetic Devices
    Prosthetic devices: 20% of the cost
    Related medical supplies: 20% of the cost

    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$6 copay$6 copay$6 copay
    Tier 2: Non-Preferred Generic$15 copay$15 copay$15 copay
    Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay
    Tier 4: Non-Preferred Brand Name$100 copay$100 copay$100 copay
    Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance
    90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
    Tier 1: Preferred Generic$18 copay$18 copay$0 copay
    Tier 2: Non-Preferred Generic$45 copay$45 copay$0 copay
    Tier 3: Preferred Brand Name$141 copay$141 copay$131 copay
    Tier 4: Non-Preferred Brand Name$300 copay$300 copay$290 copay
    Tier 5: Specialty Tier

    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
    Not Rated
    Reviewing appeals decisions
    Not Rated
    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
    Not Rated

    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 Plus H6622-001 (HMO) for Wisconsin

    /
    GEQUILLANA, GLENN
    2901 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    TRINKL, DENISE
    2900 W OKLAHOMA AVE
    MILWAUKEE, WI 53215
    CARBALLO, RICHARD
    2801 W KK RIVER PKWY
    MILWAUKEE, WI 53215
    DESHUR, WILLIAM
    2801 W KK RIVER PKWY
    MILWAUKEE, WI 53215
    GONCHAROVA, IRINA
    2801 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    WHITE, MATTHEW
    2900 W OKLAHOMA AVE
    MILWAUKEE, WI 53215
    SHAH, HEMANT
    2900 W OKLAHOMA AVE
    MILWAUKEE, WI 53215
    JHAVERI, AMIT
    2901 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    PARK, TRACY
    4111 W MITCHELL ST
    MILWAUKEE, WI 53215
    KOPLIN, STEPHANIE
    2900 W OKLAHOMA AVE
    MILWAUKEE, WI 53215
    PADUREAN, ADRIAN
    3237 S 16TH ST
    MILWAUKEE, WI 53215
    SCHULTE, MICHAEL
    3237 S 16TH STREET
    MILWAUKEE, WI 53215
    BAMRAH, BINDU
    3237 S 16TH ST
    MILWAUKEE, WI 53215
    STONE, JAMES
    3237 S 16TH ST
    MILWAUKEE, WI 53215
    ORTON, DEREK
    2801 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    IOSSI, MICHAEL
    2801 W KK RIVER PKWY
    MILWAUKEE, WI 53215
    WISKE, DANIEL
    2801 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    SCHELL, DEBRA
    2801 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    WEBBER, NICHOLAS
    2801 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    TUCKER, KEVIN
    2901 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    WIDELL, JEFF
    2900 W OKLAHOMA AVE
    MILWAUKEE, WI 53215
    MCGARTLAND, LAURA
    2801 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    BROWNE, VERON
    2801 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    AL-JAGHBEER, ESHRAQ
    2801 W KINNICKINNIC RIVER PKWY STE 245
    MILWAUKEE, WI 53215
    SHAH, KUNAL
    2901 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    Details
    GLENN GEQUILLANA, DDS
    Phone Number
    (414) 649-3510
    Office Locations
    2901 W KINNICKINNIC RIVER PKWY
    MILWAUKEE, WI 53215
    2901 W KINNICKINNIC RIVER PKWY MILWAUKEE WI, 53215

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