2018 Humana Gold Choice H8145-052 (PFFS) H8145-52-0 in PA from Humana | HealthPocket

Humana Gold Choice H8145-052 (PFFS)

$756/mo

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Zip Code19120
Applicant10/17/1983 Male
Coverage Start10/19/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH8145-52-0
Plan Year2018
CMS Rating
Plan TypePFFS
Annual Deductible$360.00

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan

Why We Like This Plan
  • has both Health and Drug Coverage

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsYes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$6,700 In and Out-of-network
Other health plan deductibles?No
Health Plan Deductible$0
Monthly Drug Plan Premium$22.00
Monthly Health Plan Premium$41.00

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:
$295 for days 1 through 6
$0 for days 7 through 90
$0 for days 91 and beyond
Out-of-Network:
$295 for days 1 through 6
$0 for days 7 through 90
Outpatient hospital coverageIn-Network:
$295 per visit
Out-of-Network:
$295 per visit
Doctor visitsPrimary:
In-Network:
$15 per visit
Out-of-Network:
$15-100 per visit
Specialist:
In-Network:
$45 per visit
Out-of-Network:
$45-295 per visit
Preventive careIn-Network:
$0 copay
Out-of-Network:
$0 copay
Emergency care/Urgent careEmergency:
$80 per visit (always covered)
Urgent care:
$15-45 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:
$0-105
Out-of-Network:
$0-105
Lab services:
In-Network:
$0-40
Out-of-Network:
$0-105
Diagnostic radiology services (e.g., MRI):
In-Network:
$45-295
Out-of-Network:
$45-295
Outpatient x-rays:
In-Network:
$15-100
Out-of-Network:
$15-100
Mental health servicesIn-Network:
$295 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
$295 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
$40-105
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
$40-105
Outpatient group therapy visit:
In-Network:
$40
Out-of-Network:
$40-105
Outpatient individual therapy visit:
In-Network:
$40
Out-of-Network:
$40-105
Skilled Nursing FacilityIn-Network:
$0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network:
$0 for days 1 through 20
$167.50 for days 21 through 100
Rehabilitation servicesOccupational therapy visit:
In-Network:
$15-40
Out-of-Network:
$15-100
Physical therapy and speech and language therapy visit:
In-Network:
$15-40
Out-of-Network:
$15-100
AmbulanceIn-Network:
$250 or 20%
Out-of-Network:
$250 or 20%
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:
$45
Out-of-Network:
$45-295
Routine foot care:
Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
20% per item
Diabetes supplies:
In-Network:
$0 or 10-20% per item
Out-of-Network:
10-20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:
20%
Out-of-Network:
20%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
20%

Coverage Area for Humana Gold Choice H8145-052 (PFFS)

StatePennsylvania
CountyPhiladelphia

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$7 copay$10 copay$7 copay
Tier 2: Non-Preferred Generic$17 copay$20 copay$17 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 Tier25% coinsurance25% coinsurance25% coinsurance

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$21 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$51 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

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 managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot Rated
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

Physicians that accept Humana Gold Choice H8145-052 (PFFS) for Pennsylvania

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Casto, Daniel
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Kramer, Jan
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Infante-gutierrez, Guillermo
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Myers, John
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Schindler, Alan
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Bell, George
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Yoo, Stanley
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Vangore, Surya
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Sridhara, Channarayapatna
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Matson, David
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Deitch, Kenneth
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Garcia, Laureano
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Walsh, Brian
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Hoellein, Kenneth
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Itskov, Boris
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Grant, Richard
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Lanoce, Gary
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Small, Ronald
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Daniel Casto, MD
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  • Phone Number
    (215) 728-7690
  • Office Locations
    5600 Tabor Ave
    Phila, PA 19120
5600 Tabor Ave Phila PA, 19120

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