2019 Humana Community (HMO) H7621-2-0 in CA from Humana | HealthPocket

Humana Community (HMO)

$0/mo

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Zip Code90011
Applicant1/22/1984 Male
Coverage Start1/23/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH7621-2-0
Plan Year2019
CMS RatingNot Rated
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
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$2,200 In-network
Optional Supplemental BenefitsYes

Benefits

SERVICECOST
Inpatient hospital coverage$0 copay per stay
Outpatient hospital coverage$0 copay
Doctor visitsPrimary:$0 copay
Specialist:$0 copay
Preventive care$0 copay
Emergency care/Urgent careEmergency:$80 per visit (always covered)
Urgent care:$0 copay
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:$0 copay
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$0-40
Outpatient x-rays:$0
Mental health servicesInpatient hospital - psychiatric:$0 copay per stay
Outpatient group therapy visit with a psychiatrist:$10
Outpatient individual therapy visit with a psychiatrist:$10
Outpatient group therapy visit:$10
Outpatient individual therapy visit:$10
Skilled Nursing Facility$0 per day for days 1 through 20
$50 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:$0 copay
Physical therapy and speech and language therapy visit:$0 copay
Ground ambulance$195
Transportation$0 copay. There may be limits on how much the plan will provide.
Foot care (podiatry services)Foot exams and treatment:$0 copay
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):$0 or 20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:$0 or 10% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:20%
Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam$0 copay
Fitting/evaluation$0 copay. There may be limits on how much the plan will provide.
Hearing aids$699-999There may be limits on how much the plan will provide.
Preventive Dental
Oral exam$0 copay. There may be limits on how much the plan will provide.
Cleaning$0 copay. There may be limits on how much the plan will provide.
Fluoride treatmentNot covered
Dental x-ray(s)$0 copay. There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative services50%There may be limits on how much the plan will provide.
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye exam$0 copay. There may be limits on how much the plan will provide.
OtherNot covered
Contact lenses$0 copay. There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)$0 copay. There may be limits on how much the plan will provide.
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for Humana Community (HMO)

StateCalifornia
CountyLos Angeles

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$0 copay$10 copay$0 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$0 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$94 copay
Tier 4: Non-Preferred Brand Name$300 copay$300 copay$200 copay
Tier 5: Specialty Tier

Physicians that accept Humana Community (HMO) for California

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Hernandez, Louis
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Sinha, Rakhi
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Ohearn, Thomas
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Cadry, Mehrangiz
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Lucas, Deborah
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Brown, Bassett
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Pushin, Mark
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Noya, David
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Chavez, Edgar
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Lara, Agustin
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Miller, David
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Aron, Monish
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Lin, Yvonne
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Ramsingh, Giridharan
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Walker, Lori
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O'connell, Casey
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Desai, Mihir
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Goldkorn, Amir
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Jennelle, Richard
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Van Orman, Sarah
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Himsl, Kyle
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Lieskovsky, Gary
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Mcnulty, Karen
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Louis Hernandez
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  • Phone Number
    (323) 234-4445
  • Office Locations
    5807 Avalon Blvd
    Los Angeles, CA 90011
5807 Avalon Blvd Los Angeles CA, 90011

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.