2018 Humana Gold Plus H2649-046 (HMO) H2649-46-0 in TX from Humana | HealthPocket

Humana Gold Plus H2649-046 (HMO)

$0/mo

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Zip Code79936
Applicant10/19/1983 Male
Coverage Start10/20/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHumana
Plan IDH2649-46-0
Plan Year2018
CMS Rating
Plan TypeHMO
Annual Deductible$250.00

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 2nd best selling plan in El Paso in 2019

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsNo
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$3,400 In-network
Other health plan deductibles?Yes
Health Plan Deductible$0
Monthly Drug Plan Premium$0.00
Monthly Health Plan Premium$0.00

Benefits

SERVICECOST
Inpatient hospital coverage$100 for days 1 through 7
$0 for days 8 through 90
$0 for days 91 and beyond
Outpatient hospital coverage$150 per visit
Doctor visitsPrimary:
$0 copay
Specialist:
$25 per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:
$100 per visit (always covered)
Urgent care:
$0-30 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
$0-75
Lab services:
$0-70
Diagnostic radiology services (e.g., MRI):
$0-100
Outpatient x-rays:
$0-75
Mental health services$100 for days 1 through 7
$0 for days 8 through 90
Outpatient group therapy visit with a psychiatrist:
$30
Outpatient individual therapy visit with a psychiatrist:
$30
Outpatient group therapy visit:
$30
Outpatient individual therapy visit:
$30
Skilled Nursing Facility$0 for days 1 through 20
$167.50 for days 21 through 100
Rehabilitation servicesOccupational therapy visit:
$25-40
Physical therapy and speech and language therapy visit:
$25-40
Ambulance$265 or 20%
Transportation$0 copay
Foot care (podiatry services)Foot exams and treatment:
$25
Routine foot care:
Not covered
Medical equipment/suppliesDurable 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 drugsChemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for Humana Gold Plus H2649-046 (HMO)

StateTexas
CountyEl Paso

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$3 copay$10 copay$3 copay
Tier 2: Non-Preferred Generic$8 copay$20 copay$8 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 Tier28% coinsurance28% coinsurance28% coinsurance

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$9 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$24 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

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccineNot Rated
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 serviceNot Rated
Overall rating of health care qualityNot Rated
Overall rating of planNot Rated
Care CoordinationNot Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health planNot Rated
Members choosing to leave the health planNot Rated
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 AccuracyNot Rated
High risk medicationNot Rated
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 Plus H2649-046 (HMO) for Texas

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Ahmad, Samir
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Botez, Maria
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Padilla, Manuel
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Wojciechowska, Joanna
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Rodriguez, Yvonne
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Marquez-smith, Teresa
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Mendoza-castillo, Rodin
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Guerrero, Richard
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De La Torre, Javier
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Acosta, Juan
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Songbandith, Victor
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Robertson, Kathleen
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Gonzalez, Jose
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Patterson, John
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Reynolds, Brian
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Liano, Ruben
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Mcdonald, Duncan
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Samir Ahmad, M.D
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  • Phone Number
    (915) 629-8100
  • Office Locations
    1600 N Lee Trevino Dr
    El Paso, TX 79936
1600 N Lee Trevino Dr El Paso TX, 79936
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