PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Humana
CMS Rating
Plan Type
HMO SNP
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 a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors for Most Services
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,400 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
$0 or $100 copay
If you are cost-share protected by the State (QMB+) you pay nothing.
Doctors Office Visits
Primary care physician visit: You pay nothing
Specialist visit: You pay nothing
Emergency Care
$0 or $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.
If you are cost-share protected by the State (QMB+) you pay nothing.
Home Health Care
You pay nothing
Mental Health Care
You pay nothing per stay
Outpatient hospital
You pay nothing
Renal dialysis
You pay nothing
Inpatient Hospital Care
You pay nothing 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): You pay nothing
Routine chiropractic visit (for up to 12 every year): You pay nothing
Diabetes Supplies and Services
Diabetes monitoring supplies: You pay nothing
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): You pay
nothing
Diagnostic tests and procedures: You pay nothing
Lab services: You pay nothing
Outpatient x-rays: You pay nothing
Therapeutic radiology services (such as radiation treatment for
cancer): You pay nothing
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): You pay nothing
Occupational therapy visit: You pay nothing
Physical therapy and speech and language therapy visit: You pay
nothing
Outpatient Substance Abuse
Group therapy visit: You pay nothing
Individual therapy visit: You pay nothing
Outpatient Surgery
Ambulatory surgical center: You pay nothing
Outpatient hospital: You pay nothing
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
You pay nothing
Transportation
You pay nothing
– 4 one-way non-emergency trips per year for plan approved
locations.
Vision Services
Exam to diagnose and treat diseases and conditions of the eye
(including yearly glaucoma screening): You pay nothing
Routine eye exam (for up to 1 every year): You pay nothing
Contact lenses (for up to 1 every year): $0 copay
Eyeglasses (frames and lenses) (for up to 1 every year): $0 copay
Eyeglasses or contact lenses after cataract surgery: You pay nothing
Our plan pays up to $50 every year for contact lenses and eyeglasses
(frames and lenses).
OR
1 pair of free select eyeglasses per year. Any additional upgrades to
the select pair will be at your cost.
Eyeglasses will include ultraviolet protection coating and scratch
resistance coating.
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.
    Annual physical exam: You pay nothing
    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.
  • You pay nothing

  • You pay nothing per day for days 91 and beyond

  • You pay this amount each time you are admitted or transferred to a
    facility.
    If you are cost-share protected by the State (QMB+) you pay nothing.
    Durable Medical Equipment
    You pay nothing
    Urgent Care
    You pay nothing
    Skilled Nursing Facility
    Our plan covers up to 100 days in a SNF.
  • You pay nothing

  • If you are cost-share protected by the State (QMB+) you pay nothing.
    Prosthetic Devices
    Prosthetic devices: You pay nothing
    Related medical supplies: You pay nothing

    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$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$0 copay$0 copay$0 copay
    Tier 2: Non-Preferred Generic$0 copay$0 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
    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
    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 Plus SNP-DE H1036-104A (HMO SNP) for Florida

    /
    MEZEY, ROBERT
    12600 SW 120TH ST
    MIAMI, FL 33186
    HERRERA, MAURICIO
    11801 SW 90TH ST
    MIAMI, FL 33186
    SCHNEIDER, JESSICA
    12608 SW 88TH ST
    MIAMI, FL 33186
    CALAFELL, YESIM
    14261 SW 120TH STREET
    MIAMI, FL 33186
    MCCARTHY, LIAM
    11801 SW 90TH ST
    MIAMI, FL 33186
    GARCIA-ORTIZ, SANDRA
    11435 SW 133RD CT APT 3
    MIAMI, FL 33186
    HERNANDEZ, OSCAR
    14221 SW 120TH ST
    MIAMI, FL 33186
    ESPINOSA, CARMEN
    13550 SW 88TH STREET STE 280
    MIAMI, FL 33186
    VAZQUEZ, NELSON
    13500 SW 88 ST
    KENDALL, FL 33186
    JIMENEZ, MILTON
    12002 SW 128TH CT STE 204
    MIAMI, FL 33186
    GERSTEN, JANET
    8900 SW 117TH AVE
    MIAMI, FL 33186
    PONS, FRANCISCO
    13500 SW 88TH ST
    MIAMI, FL 33186
    SHAH, CHANDRAKANT
    13033 SW 112TH ST
    MIAMI, FL 33186
    BUIA, MONTSERRAT
    11801 SW 90TH ST
    MIAMI, FL 33186
    RODICIO, ILEANA
    9000 SW 137TH AVE
    MIAMI, FL 33186
    MENENDEZ, COREN
    12314 SW 127 AVENUE
    MIAMI, FL 33186
    NUNEZ, RIGOBERTO
    8900 SW 117TH AVE
    MIAMI, FL 33186
    GOMEZ, MANUEL
    13000 SW 117 STREET
    MIAMI, FL 33186
    GOYKHMAN, GARY
    11801 SW 90TH ST
    MIAMI, FL 33186
    GUPTA, PADMA
    13500 SW 88TH ST
    MIAMI, FL 33186
    CINTAS, MAURA
    9000 SW 137TH AVE
    MIAMI, FL 33186
    MAYORGA, RENE
    14261 SW 120TH ST STE 110
    MIAMI, FL 33186
    RAJADHYAKSHA, AMAR
    11801 SW 90TH ST
    MIAMI, FL 33186
    KARSENTI, REBECCA
    8900 SW 117TH AVE
    MIAMI, FL 33186
    OROZCO, JUAN
    14687 SW 104TH ST
    MIAMI, FL 33186
    Details
    ROBERT MEZEY, M.D., F.C.C.P.
    Phone Number
    (305) 255-0777
    Office Locations
    12600 SW 120TH ST
    MIAMI, FL 33186
    12600 SW 120TH ST MIAMI FL, 33186

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