Humana Gold Plus H1951-049 (HMO)

Medicare Advantage Plan for Louisiana

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH1951-49-3
CMS Rating1
Plan TypeHMO
Annual Deductible$200.00

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 3rd best selling plan in Caldwell Parish in 2018

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
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
$215 for days 1 through 8
$0 for days 9 through 90
$0 for days 91 and beyond
Outpatient hospital coverage
$275 per visit
Doctor visits
Primary:$15 per visit
Specialist:$45 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:$80 per visit (always covered)
Urgent care:$15-45 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:$0-50
Lab services:$0-40
Diagnostic radiology services (e.g., MRI):$0-250
Outpatient x-rays:$0-50
Mental health services
$215 for days 1 through 7
$0 for days 8 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
$164.50 for days 21 through 100
Rehabilitation services
Occupational therapy visit:$15
Physical therapy and speech and language therapy visit:$15
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 H1951-049 (HMO)

StateLouisiana
CountyEast Baton Rouge Parish

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$6 copay$10 copay$6 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$99 copay$100 copay$99 copay
Tier 5: Specialty Tier29% coinsurance29% coinsurance29% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$18 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$297 copay$300 copay$287 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 H1951-049 (HMO) for Louisiana

/
BALDRIDGE, LISA
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
VENUS/NEUROPATHY TREATMENT CENTERS OF LA,LLC
3233 S SHERWOOD FOREST BLVD
BATON ROUGE, LA 70816
HOLMES, KEITH
2345 ONEAL LN
BATON ROUGE, LA 70816
POINTER, ROSE
11140 N HARRELLS FERRY RD
BATON ROUGE, LA 70816
JOHNSTON, FRANCIS
1940 ONEAL LN
BATON ROUGE, LA 70816
SILVIO, KAYLA
11140 N. HARRELLS FERRY RD.
BATON ROUGE, LA 70816
CHAPMAN, KAYLA
11140 N. HARRELLS FERRY ROAD
BATON ROUGE, LA 70816
STAFFORD, ANGELA
15420 S HARRELLS FERRY RD
BATON ROUGE, LA 70816
BULLER, MYRA
8015 ROD LAVER AVE
BATON ROUGE, LA 70810
HARRIS, ANGELA
16777 MEDICAL CENTER DRIVE
BATON ROUGE, LA 70816
MORVANT, KRISTIN
16777 MEDICAL CENTER
BATON ROUGE, LA 70816
IDOWU, BEN
17050 MEDICAL CENTER DR
BATON ROUGE, LA 70816
WAHID, SAIYID
1962 ONEAL LN
BATON ROUGE, LA 70816
NNADI, JOHN
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
PATEL, PALVI
7777 HENNESSY BLVD
BATON ROUGE, LA 70808
BAUCOM, CATHERINE
17050 MEDICAL CENTER DR
BATON ROUGE, LA 70816
LANE, MICHAEL
10632 ALCO AVE
BATON ROUGE, LA 70816
JOHN, MARKUS
4021 WE HECK CT
BATON ROUGE, LA 70816
FERGUSON, DANIEL
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
KOZAR, BRIAN
16777 MEDICAL CENTER DR
BATON ROUGE, LA 70816
ELLIOTT, ROBERT
17050 MEDICAL CENTER DR STE 400
BATON ROUGE, LA 70816
MCCAULEY, LINDA
16777 MEDICAL CENTER DR
BATON ROUGE, LA 70816
MCKINNEY, ROBERT
2345 ONEAL LN
BATON ROUGE, LA 70816
GESN, LOIS
2345 ONEAL LN
BATON ROUGE, LA 70816
Details
LISA BALDRIDGE, DO
Phone Number
(225) 752-2470
Office Locations
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
17000 MEDICAL CENTER DR BATON ROUGE LA, 70816

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