Humana Gold Choice H8145-126 is a Medicare Advantage plan, from Humana Insurance Company, available in Tyler County, Texas. This is a Private Fee-for-Service (PFFS) option for people with Medicare Part A and Part B benefits. It does not include a prescription drug plan.
You can reach Humana Insurance Company directly at (800)833-2364 or (711)- for TTY users.
About PFFS Plans without Part D
With a PFFS health plan like this one, you can use any physician or specialist you like, so long as they agree to the plan's payment terms.
Some PFFS plans bring together all of the benefits of original Medicare, prescription drug coverage and other extras into one plan that's typically a lot less expensive than adding a Medicare Supplement and a prescription drug plan to your basic benefits. If this is what you're looking for, make sure you read all of the details.
IMPORTANT: A PFFS plan may sound like Original Medicare with Medicare Supplement insurance, but it's not the same. The biggest difference is that your healthcare providers can continue to treat you so long as they accept the terms and conditions of payment. They can also choose not to treat you, unless it's an emergency, if they don't accept the payment terms. Check with your primary care doctor and specialists before you enroll.
NOTE: Humana Gold Choice H8145-126 does not include prescription drug coverage. To get it, you can add one of the stand-alone Medicare Part D plans available in Texas.
The premium on this plan is $20.00 per month. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventative care mandated by CMS (see H8145-126 Summary of Benefits below).
IMPORTANT: When evaluating this plan, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.
Maximum Out-of-Pocket (MOOP) Limit for Parts A & B
Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The Humana Gold Choice H8145-126 plan MOOP is N/A . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.
Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.
NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.
CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medigap plan in Tyler County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.
In this section we show you the quality rating for this plan. Each year the Centers for Medicare and Medicaid Services (CMS) rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this Humana Insurance Company plan.
|2016 Overall Rating|
|Part C Summary Rating|
|Part D Summary Rating|
|Staying Healthy: Screenings, Tests, Vaccines|
|Managing Chronic (Long Term) Conditions|
|Member Experience with Health Plan|
|Complaints and Changes in Plans Performance|
|Health Plan Customer Service|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
Part D Prescription Drug Benefits
This plan does not include prescription drug benefits. You can purchase a Texas Medicare Part D plan to use with this health plan.
Summary of Benefits (H8145-126)
In this section we outline high-level information about the plan's co-payment and co-insurance costs for inpatient, outpatient, preventive care, transportation and other healthcare services. For complete details, download the Humana Gold Choice H8145-126 Summary of Benefits.
Outpatient Care and Services
All outpatient health care services (Medicare Part B benefits) have their own co-payment or co-insurance costs. Here's how this plan charges for the basics.
|Primary Care Doctor:||20% co-insurance|
|Physician Specialist:||$45 co-payment|
|Occupational Therapist:||$25 co-payment|
|Physical Therapist:||$25 co-payment|
|Speech Terapist:||$25 co-payment|
Lab and Diagnostic Services
Lab and diagnostic services have co-payment or co-insurance costs. Some plans offer these services at no cost, but most do not.
|Medicare-covered Diagnostic Procedures/Tests:||$0 to $50 co-payment|
|Medicare-covered Lab Services:||$0 to $50 co-payment|
|Medicare-covered Diagnostic Radiological Services:||20% co-insurance|
|Medicare-covered Therapeutic Radiological Services||20% co-insurance|
|Medicare-covered X-Ray Services||$10 to $50 co-payment|
Urgent Care and Emergency Services
Urgent care and emergency room services (Medicare Part B benefits) have co-payment or co-insurance costs. Some plans waive these costs if you are admitted as an inpatient within a specified amount of time. Also, plans are not required to offer emergency care worldwide.
|Urgent Care:||30% co-insurance|
|Emergency Care:||$75 co-payment|
|Worldwide Coverage:||Yes ($25,000 limit)|
Medicare Preventive Care
Humana Gold Choice H8145-126 covers preventive services, as required by law under Medicare Part B, including:
- Abdominal aortic aneurysm screening
- Alcohol misuse counseling
- Bone mass measurement
- Breast cancer screening (mammogram)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular screenings
- Cervical and vaginal cancer screening
- Colorectal cancer screenings
- Depression screening
- Diabetes screenings
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
- "Welcome to Medicare" preventive visit
- Yearly "Wellness" visit
All preventive healthcare services are provided at no cost to the beneficiary. Any additional preventative services approved by Medicare during the contract year will be covered.
Inpatient Care and Services
When you are admitted into a hospital or skilled nursing facility you will make copayments based on benefit periods. A benefit period begins when you are admitted and ends after not receiving inpatient care for 60 days in a row. If you are admitted again after a benefit period has ended a new benefit period begins.
You are required to pay an inpatient deductible for each benefit period. There are no limits on the the number of benefit periods. Here's how this plan charges:
- Day 1 to 7 you pay $275 per day
- See the Summary of Benefits for additional copayment periods.
You pay nothing for hospice care from a Medicare-approved (certified) hospice facility. You may have to pay some of the cost for drugs and respite care.
Humana Gold Choice H8145-126 is available to beneficiaries living in Chester, Colmesneil, Doucette, Woodville, Fred, Hillister, Spurger, Warren, and all other areas of Tyler County, Texas.
For assistance 24 hours a day, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048 or visit www.medicare.gov
Tips and Disclaimers
The Medicare Advantage plan data on MedicareWire.com comes directly from Medicare.gov and CMS.gov and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.
The benefit information provided on this page is a brief summary only, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly at (800)833-2364 or (711)- for TTY users.
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This Medicare Part C information is maintained by David Bynon and was last updated on .