On this page we help consumers: Compare Humana Gold Plus H6622-036 with all 2020 Medicare Advantage Plans available in Lackawanna County, Pennsylvania. This is a HMO plan with a $0.00/mo premium and $6,700 max out-of-pocket limit.
What is Humana Gold Plus H6622-036?
Humana Gold Plus H6622-036 is a 2020 Medicare Advantage plan, from Humana, available in Lackawanna County, Pennsylvania.
- It's a Health Maintenance Organization (HMO) health plan.
- It includes a prescription drug plan (Part D).
- It has the same health insurance benefits as Original Medicare.
- It offers extras that Medicare does not cover.
- The maximum out-of-pocket cost with this plan is $6,700 .
- The monthly premium is $0.00 (plus your Part B premium).
Humana Gold Plus H6622-036 vs. Medicare
This HMO plan replaces your Original Medicare coverage. If you enroll, you agree to let Humana manage your Medicare benefits.
The benefit of an HMO plan is lower, predictable out-of-pocket expenses. Although more restrictive than Original Medicare, HMOs limit your annual out-of-pocket costs. With traditional Medicare there's no cap, leaving you vulnerable to excessive medical bills.
Humana Gold Plus H6622-036 Review
These are the areas of the plan that are important to compare and review:
- Premium: This is the amount you will pay monthly, above and beyond your Medicare Part B.
- Maximum-Out-Of-Pocket (MOOP): This is the most you will pay for co-pays and co-insurance before the plan pays 100%.
- CMS Ratings: Important measurements across 9 different areas that will help you understand how well this plan will care for you.
- Prescription Coverage: Medications are expensive, so you'll want to know how this plan covers your prescriptions.
- Co-pays & Co-insurance: If you see the doctor regularly, including specialists, you need to know what you'll pay for each visit.
IMPORTANT: With an HMO you are required to use healthcare providers in the plan's network. If you don't you will incur additional costs. Also, be aware that your primary care physician must refer you before you can see a specialist.
CRITICAL: Humana Gold Plus H6622-036 includes a Medicare Drug Plan which has its own deductible and co-pays. If you have regular prescriptions, make sure they are covered at a favorable price before you join this plan. Prescription drug plans vary significantly by plan. Make sure you have the best coverage.
How Much Does Humana Gold Plus H6622-036 Cost?
The premium on this plan is $0.00 per month. That includes your prescription drugs, as well. 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 preventive care mandated by CMS (see H6622-036 Summary of Benefits below).
Although the health plan itself does not have a deductible, the prescription drug plan does. It's $0.00 per year. That means you have first dollar coverage.
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.
What is the Maximum Out-of-Pocket (MOOP) Limit?
Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The Humana Gold Plus H6622-036 plan MOOP is $6,700 . 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 Medicare Supplement in Lackawanna County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.
Medicare 5-Star Ratings
In this section we show you the quality rating for this Humana plan. Each year 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 health plan.
Does Humana Gold Plus H6622-036 include Medicare Part D?
This plan includes prescription drug coverage (Medicare Part D). If you have regular prescriptions, it's critical that you evaluate your costs using the plan's formulary.
In addition to the monthly premium and Part D deductible, the drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the drug coverage schedule for this plan:
|1 (Preferred Generic)||$3.00 copay||$10.00 copay|
|2 (Generic)||$15.00 copay||$20.00 copay|
|3 (Preferred Brand)||$47.00 copay||$47.00 copay|
|4 (Non-Preferred Drug)||$100.00 copay||$100.00 copay|
|5 (Specialty Tier)||33%||33%|
How Much are the Copays & Co-Insurance?
In this Summary of Benefits 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 or assistance call: 1-855-266-4865.
Humana Gold Plus H6622-036 vs. Medigap
To compare Humana Gold Plus H6622-036 with a Medigap plan (Medicare supplemental insurance), you need to evaluate your healthcare and financial needs. Look at the total potential cost with each plan type, not just the monthly premium, and choose how you want to use medical care (locally or nationally).
To help you make a better decision, we created our How-to Choose the Best Medicare Plan guide. It will help you understand how to compare Humana Gold Plus H6622-036 with Medicare Supplement plans in Pennsylvania. Medicare Plan F in Pennsylvania is the most popular.
For more information about this plan, call the Enrollment Assistance line, or visit the Enrollment Website or the plan website:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov or the Wikipedia page. To learn more about this plan, visit the Humana Medicare website.
Additional Plan Options in Lackawanna County
Are you eligible for a Lackawanna County, PA Medicare Special Needs Plan (SNP)? SNPs are a special type of Medicare Advantage plan designed to help people with special needs. Here are some of the SNP plans in your area:
- Allwell Dual Medicare (Local HMO), for Dual-Eligible beneficiaries
- Geisinger Gold Secure Rx (Local HMO), for Dual-Eligible beneficiaries
- Humana Gold Plus SNP-DE H6622-038 (Local HMO), for Dual-Eligible beneficiaries
- UPMC for Life Dual (Local HMO), for Dual-Eligible beneficiaries
- UnitedHealthcare Nursing Home Plan 2 (Local PPO), for Institutional beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- UPMC for Life HMO Rx Enhanced (HMO)
- UPMC for Life HMO Deductible with Rx (HMO)
- Geisinger Gold Preferred Complete Rx (PPO)
- Aetna Medicare Advantra Credit Value (PPO)
- Aetna Medicare Advantra Silver (PPO)
Medicare Part C Plan Availability
Humana Gold Plus H6622-036 is available to beneficiaries living in Archbald, Carbondale, Chinchilla, Clarks Summit, Dalton, Elmhurst, Fleetville, Jermyn, Jessup, La Plume, Moscow, Olyphant, Peckville, Waverly, Scranton, Moosic, Taylor, Old Forge, Ransom, and all other areas of Lackawanna County, Pennsylvania; Medicare plans are the same throughout the County.