Humana Gold Plus SNP-DE H1036-241 (HMO SNP)

Medicare Advantage Plan for Florida

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH1036-241-0
CMS Rating1
Plan TypeHMO SNP
Annual Deductible$330.00

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)

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$22.70
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
$0 or $125 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Outpatient hospital coverage
$0 copay
Doctor visits
Primary:
$0 copay
Specialist:
$0 copay
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$0 or $80 per visit (always covered)
Urgent care:
$0 copay
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
$0 copay
Lab services:
$0 copay
Diagnostic radiology services (e.g., MRI):
$0 copay
Outpatient x-rays:
$0 copay
Mental health services
$0 or $125 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
$0 copay
Outpatient individual therapy visit with a psychiatrist:
$0 copay
Outpatient group therapy visit:
$0 copay
Outpatient individual therapy visit:
$0 copay
Skilled Nursing Facility
$0 for days 1 through 20
$0 or $155 for days 21 through 100
Rehabilitation services
Occupational therapy visit:
$0 copay
Physical therapy and speech and language therapy visit:
$0 copay
Ambulance
$0 or $200 or 20%
Transportation
$0 copay
Foot care (podiatry services)
Foot exams and treatment:
$0 copay
Routine foot care:
$0 copay
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
$0 copay
Prosthetics (e.g., braces, artificial limbs):
$0 copay
Diabetes supplies:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
$0 copay
Other Part B drugs:
$0 copay

Coverage Area for Humana Gold Plus SNP-DE H1036-241 (HMO SNP)

StateFlorida
CountyMiami-Dade

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$0 copay$10 copay$0 copay
Tier 2: Non-Preferred Generic$10 copay$20 copay$10 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 Tier26% coinsurance26% coinsurance26% 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$30 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
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 H1036-241 (HMO SNP) for Florida

/
COHEN, SHELDON
9000 SW 137TH AVE
MIAMI, FL 33186
ROJAS, ROMEO
12002 SW 128TH CT STE 204
MIAMI, FL 33186
AREVALO, EDITH
12608 SW 88TH ST
MIAMI, FL 33186
PANDO, JARY
13001 SW 88TH ST
MIAMI, FL 33186
GERSTEN, JANET
8900 SW 117TH AVE
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
ARRAZOLA, ORLANDO
13550 SW 88TH ST STE 280A
MIAMI, FL 33186
JIMENEZ, MILTON
12002 SW 128TH CT STE 204
MIAMI, FL 33186
JARRETT, WENTWORTH
12955 SW 132ND ST
MIAMI, FL 33186
NUNEZ, RIGOBERTO
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
RAJADHYAKSHA, AMAR
11801 SW 90TH ST
MIAMI, FL 33186
CINTAS, MAURA
9000 SW 137TH AVE
MIAMI, FL 33186
RODICIO, ILEANA
9000 SW 137TH AVE
MIAMI, FL 33186
MAYORGA, RENE
14261 SW 120TH ST STE 110
MIAMI, FL 33186
BUIA, MONTSERRAT
11801 SW 90TH ST
MIAMI, FL 33186
MAFUT, DAMARIS
9020 SW 137TH AVE STE 200
MIAMI, FL 33186
NEELY, MICHELLE
13500 SW 88TH ST
MIAMI, FL 33186
Details
SHELDON COHEN, M.D.
Phone Number
(305) 380-6773
Office Locations
9000 SW 137TH AVE
MIAMI, FL 33186
9000 SW 137TH AVE MIAMI FL, 33186

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