2018 Humana Gold Plus SNP-DE H4007-016 (HMO SNP) H4007-16-0 in PR from Humana | HealthPocket

Humana Gold Plus SNP-DE H4007-016 (HMO SNP)

Medicare Advantage Plan for Puerto Rico

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH4007-16-0
CMS Rating1
Plan TypeHMO SNP
Annual Deductible$405.00

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

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)
$3,400 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
$0 copay per stay
Outpatient hospital coverage
$0 copay
Doctor visits
Primary:
$0 copay
Specialist:
$0 copay
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$0 copay
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 copay per stay
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 copay
Rehabilitation services
Occupational therapy visit:
$0 copay
Physical therapy and speech and language therapy visit:
$0 copay
Ambulance
$0 copay
Transportation
$0 copay
Foot care (podiatry services)
Foot exams and treatment:
$0 copay
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
0% or 5% per item
Prosthetics (e.g., braces, artificial limbs):
0% or 5% per item
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 H4007-016 (HMO SNP)

StatePuerto Rico
CountySan Juan

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 GenericNot offereds25% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered25% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 4: Non-Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 5: Specialty TierNot offered25% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered25% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered25% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 4: Non-Preferred Brand NameNot offered25% coinsuranceNot offered
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
Not Rated

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
Not Rated
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 H4007-016 (HMO SNP) for Puerto Rico

/
DRA CARMEN M MARRERO PSC
488 CARR 845
SAN JUAN, PR 00926
MIESES, EDDY
D3 FRONTERA AVE VILLA ANDALUCIA
RIOS PIEDRAS, PR 00926
PACHECO-LOPEZ, PAULETTE
3950 CARR 176
SAN JUAN, PR 00926
ALVARADO-MELENDEZ, RICARDO
840 CARR 877 APT 312
SAN JUAN, PR 00926
DIEZ-DELGADO, RICARDO
124 AVE WINSTON CHURCHILL
SAN JUAN, PR 00926
QUILICHINI, JOSE
1629 SANTA EDUVIGIS
SAN JUAN, PR 00926
TORRES NIEVES, ARMANDO
PASEO MAYOR
SAN JUAN, PR 00926
SALINAS-SEINE, GLORIA
124 AVE WINSTON CHURCHILL
SAN JUAN, PR 00926
MULERO FERNANDEZ, JOSE
ROMANY GARDENS
SAN JUAN, PR 00926
FERNANDEZ ESTEVES, YANIRA
ROMANY GARDENS
SAN JUAN, PR 00926
MARRERO, CARMEN
488 CARR 845
SAN JUAN, PR 00926
GRUPO DE SERVICIOS GERIATRICO
488 CARR 845
SAN JUAN, PR 00926
CALIMANO, CARLOS
W5-5 CALLE PIO BAROJA
SAN JUAN, PR 00926
HERNANDEZ, JORGE
UPR, MEDICAL SCIENCES CAMPUS
SAN JUAN, PR 00936
GONZALEZ-CANCEL, IVAN
AVE AMERICO MIRANDA
SAN JUAN, PR 00927
FRONTERA, WALTER
2 CALLE AZUCENA
SAN JUAN, PR 00927
ROMAN - GARCIA, ANA
CONDOMINIO FIRST FEDERAL DE RIO PIEDRAS
SAN JUAN, PR 00927
CASILLAS, STELLA
1890 CALLE PETUNIA
SAN JUAN, PR 00927
PENA JIMENO, IVELISSE
346 CALLE 32
SAN JUAN, PR 00927
ZEGARRA, JAN
DE DIEGO AVENUE 201
SAN JUAN, PR 00927
Details
DRA CARMEN M MARRERO PSC
Phone Number
(787) 761-1943
Office Locations
488 CARR 845
SAN JUAN, PR 00926
488 CARR 845 SAN JUAN PR, 00926

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