Humana Gold Plus H2649-063 (HMO)

Medicare Advantage Plan for Arizona

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH2649-63-0
CMS Rating1
Plan TypeHMO
Annual Deductible$0.00

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

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)
$3,200 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
$175 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Outpatient hospital coverage
$150 per visit
Doctor visits
Primary:
$0-20 per visit
Specialist:
$25 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$0-35 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
$0-100
Lab services:
$0-85
Diagnostic radiology services (e.g., MRI):
$0-150
Outpatient x-rays:
$0-100
Mental health services
$175 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
$167.50 for days 21 through 100
Rehabilitation services
Occupational therapy visit:
$25
Physical therapy and speech and language therapy visit:
$25
Ambulance
$265 or 20%
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$25
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 H2649-063 (HMO)

StateArizona
CountyYuma

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$2 copay$10 copay$2 copay
Tier 2: Non-Preferred Generic$5 copay$20 copay$5 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 Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$6 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$15 copay$60 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
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 H2649-063 (HMO) for Arizona

/
KHONA, RAJESH
2400 S AVENUE A
YUMA, AZ 85364
LITOFE, TIMOTHY
3824 W 26TH PL
YUMA, AZ 85364
ZARGARIAN, MOHAMMAD
2060 W 24TH ST
YUMA, AZ 85364
PLANTE, MARK
381 S MAIN ST
YUMA, AZ 85364
THANT, DIANA
1030 W 24TH ST
YUMA, AZ 85364
SMYTHE, ROBERT
2775 S 8TH AVE
YUMA, AZ 85364
LAU, AUGUSTINE
2375 S. RIDGEVIEW DRIVE
YUMA, AZ 85364
THOMAS, RODNEY
1951 W 25TH STREET
YUMA, AZ 85364
HERMENAU, SHAWN
2851 S AVENUE B
YUMA, AZ 85364
BELLOT, ISABEL
2851 S AVE B
YUMA, AZ 85364
COHEN, STANTON
1743 W 24TH ST
YUMA, AZ 85364
SUBBU, SONAL
2150 W 24TH ST
YUMA, AZ 85364
CLARK, RICK
1394 W 16TH ST
YUMA, AZ 85364
GALANG, TIMOTHY
1320 W 24TH ST
YUMA, AZ 85364
GROGAN, BRIAN
2911 S 8TH AVE
YUMA, AZ 85364
GASCA-HOLTZ, MARIA
2911 S 8TH AVE
YUMA, AZ 85364
MARTINEZ, ERICK
2911 S 8TH AVE
YUMA, AZ 85364
SUCIU, THOMAS
2911 S 8TH AVE
YUMA, AZ 85364
WESTER-EBBINGHAUS, WERNER
2911 S 8TH AVE
YUMA, AZ 85364
WARDA, GREGORY
2400 S AVENUE A
YUMA, AZ 85364
NGUYEN, LOC
1001 W 16TH ST
YUMA, AZ 85364
MATOS, EMILIA
1073 W 23RD ST
YUMA, AZ 85364
HOURANI, ABDULKADIR
2051 W 25TH ST
YUMA, AZ 85364
WONG, DOROTHY
1025 W 24TH ST
YUMA, AZ 85364
RATHLE, HABIB
1025 W 24TH ST
YUMA, AZ 85364
Details
RAJESH KHONA, M.D.
Phone Number
(602) 273-6770
Office Locations
2400 S AVENUE A
YUMA, AZ 85364
2400 S AVENUE A YUMA AZ, 85364

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