Humana Gold Plus H5619-089 (HMO)

Medicare Advantage Plan for Alabama

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH5619-89-0
CMS Rating1
Plan TypeHMO
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 2nd best selling plan in Baldwin in 2018

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$6,300 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
Inpatient hospital coverage
$275 for days 1 through 7
$0 for days 8 through 90
$0 for days 91 and beyond
Outpatient hospital coverage
$275 per visit
Doctor visits
Primary:
$0 copay
Specialist:
$45 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$0-45 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
$0-50
Lab services:
$0-45
Diagnostic radiology services (e.g., MRI):
$0-275
Outpatient x-rays:
$0-50
Mental health services
$275 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
$40
Outpatient individual therapy visit with a psychiatrist:
$40
Outpatient group therapy visit:
$40
Outpatient individual therapy visit:
$40
Skilled Nursing Facility
$0 for days 1 through 20
$167 for days 21 through 100
Rehabilitation services
Occupational therapy visit:
$10
Physical therapy and speech and language therapy visit:
$10
Ambulance
$265 or 20%
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$45
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
$0 or 10-20% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for Humana Gold Plus H5619-089 (HMO)

StateAlabama
CountyJefferson

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$7 copay$10 copay$7 copay
Tier 2: Non-Preferred Generic$17 copay$20 copay$17 copay
Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Brand Name$97 copay$100 copay$97 copay
Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$21 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$51 copay$60 copay$0 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$131 copay
Tier 4: Non-Preferred Brand Name$291 copay$300 copay$281 copay
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Not Rated
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
Not Rated
Overall rating of health care quality
Not Rated
Overall rating of plan
Not Rated
Care Coordination
Not Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Not Rated
Members choosing to leave the health plan
Not Rated
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
Not Rated
High risk medication
Not Rated
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 H5619-089 (HMO) for Alabama

/
CUSTIS, JAMES
9772 PARKWAY E
BIRMINGHAM, AL 35215
SIMS, MARION
2152 OLD SPRINGVILLE ROAD
BIRMINGHAM, AL 35215
PIKE, BOB
9772 PARKWAY E
BIRMINGHAM, AL 35215
GONZALEZ, ENGLISH
2152 OLD SPRINGVILLE ROAD
BIRMINGHAM, AL 35215
GOTFRYD, MARK
1703 CENTER POINT PKWY
BIRMINGHAM, AL 35215
OWENS, KIMBERLY
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
KING, DUANE
1160 HUFFMAN ROAD
BIRMINGHAM, AL 35215
GRAY, GARY
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
TOBE-DONOHUE, COLLEEN
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
MOREHEAD, MARTHA
2152 OLD SPRINGVILLE ROAD
BIRMINGHAM, AL 35215
SULLIVAN, JAMES
1160 HUFFMAN RD
BIRMINGHAM, AL 35215
PETERS, DEBORAH
9772 PARKWAY E
BIRMINGHAM, AL 35215
GIAMMANCO, NATALIE
1985 AL HIGHWAY 157
CULLMAN, AL 35058
MOORE, KATHERINE
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
POWELL, MICHAEL
9772 PARKWAY E
BIRMINGHAM, AL 35215
ZAHARIAS, NERRIN
52 MEDICAL PARK DR E
BIRMINGHAM, AL 35235
GILMER, MARY
1801 GADSDEN HWY
BIRMINGHAM, AL 35235
DAVIS, DELINDA
3729 MARY TAYLOR RD
BIRMINGHAM, AL 35235
Details
JAMES CUSTIS, MD
Phone Number
(205) 833-6888
Office Locations
9772 PARKWAY E
BIRMINGHAM, AL 35215
9772 PARKWAY E BIRMINGHAM AL, 35215

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