Plan Details
Costs and Other Important Information
Benefits
$0 for days 6 through 90
$0 for days 91 and beyond
$0 copay
Specialist:
$40 per visit
$80 per visit (always covered)
Urgent care:
$0-40 per visit (always covered)
$0-195
Lab services:
$0-120
Diagnostic radiology services (e.g., MRI):
$25-195
Outpatient x-rays:
$0-150
$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
$150 for days 21 through 100
$40
Physical therapy and speech and language therapy visit:
$40
$40
Routine foot care:
Not covered
$0 or 20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
$0 or 20% per item
20%
Other Part B drugs:
20%
Coverage Area for Humana Gold Plus H1036-265 (HMO)
State | Florida |
---|---|
County | Miami-Dade |
Cost Sharing Information
All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit
30 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
---|---|---|---|
Tier 1: Preferred Generic | $0 copay | $10 copay | $0 copay |
Tier 2: Non-Preferred Generic | $10 copay | $20 copay | $10 copay |
Tier 3: Preferred Brand Name | $45 copay | $47 copay | $45 copay |
Tier 4: Non-Preferred Brand Name | $95 copay | $100 copay | $95 copay |
Tier 5: Specialty Tier | 33% coinsurance | 33% coinsurance | 33% coinsurance |
90 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
---|---|---|---|
Tier 1: Preferred Generic | $0 copay | $30 copay | $0 copay |
Tier 2: Non-Preferred Generic | $30 copay | $60 copay | $0 copay |
Tier 3: Preferred Brand Name | $135 copay | $141 copay | $125 copay |
Tier 4: Non-Preferred Brand Name | $285 copay | $300 copay | $275 copay |
Tier 5: Specialty Tier |
CMS Ratings
Staying healthy - screenings, tests and vaccines
Managing Chronic Conditions
Member Experience with Health Plan
Member Complaints, and Changes in Health Plan's Performance
Health Plan Customer Service
Drug Plan Customer Service
Member Complaints, and Changes in Drug Plan's Performance
Member Experience with Drug Plan
Drug Pricing and Patient Safety
Physician Finder
Physicians that accept Humana Gold Plus H1036-265 (HMO) for Florida