On this page we help consumers: Compare Humana Gold Choice H8145-052 with all 2020 Medicare Advantage Plans available in Berks County, Pennsylvania. This is a PFFS plan with a $74.00/mo premium and $- max out-of-pocket limit.
Humana Gold Choice H8145-052 2020 Medicare Advantage PFFS Plan for Berks County, PA
Humana Gold Choice H8145-052 is a Medicare Advantage plan, from Humana, that's available to Medicare beneficiaries living in Berks County, Pennsylvania. This is a Private Fee-for-Service (PFFS) health plan option with prescription coverage.
PFFS plans appear similar to Original Medicare and Medigap, but they are slightly different. Specifically, the plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you use healthcare services. That means you can use any physician or specialist you like, so long as they agree to the plan's payment terms.
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: 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.
CRITICAL: Humana Gold Choice H8145-052 includes a drug plan that has its own deductible and co-pays. If you have prescriptions, make sure your drugs are covered at a favorable price before you join this plan.
How Much Does Humana Gold Choice H8145-052 Cost?
The premium on this plan is $74.00 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 H8145-052 Summary of Benefits below).
Although the health plan itself does not have a deductible, the prescription drug plan does. It's $360.00 per year. That means you pay 100% of your prescription costs until you've spent $360.00, then the plan will begin paying it's share.
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 Choice H8145-052 plan MOOP is $- . 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 Berks 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 Choice H8145-052 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)||$7.00 copay||$10.00 copay|
|2 (Generic)||$17.00 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)||26%||26%|
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 Choice H8145-052 vs. Medigap
To compare Humana Gold Choice H8145-052 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 Choice H8145-052 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 Berks County
Are you eligible for a Berks 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:
- UnitedHealthcare Nursing Home Plan 2 (Local PPO), for Institutional beneficiaries
- Allwell Dual Medicare (Local HMO), for Dual-Eligible beneficiaries
- UnitedHealthcare Dual Complete (Local HMO), for Dual-Eligible beneficiaries
- Geisinger Gold Secure Rx (Local HMO), for Dual-Eligible beneficiaries
- Aetna Medicare Advantra Cares (Local HMO), for Dual-Eligible beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- Lasso Healthcare (MSA)
- AARP Medicare Advantage (HMO)
- AARP Medicare Advantage Choice Plan 1 (PPO)
- AARP Medicare Advantage Choice Plan 2 (PPO)
- AARP Medicare Advantage Choice Plan 3 (PPO)
Medicare Part C Plan Availability
Humana Gold Choice H8145-052 is available to beneficiaries living in Hereford, Bally, Barto, Bechtelsville, Bernville, Bethel, Birdsboro, Blandon, Bowers, Boyertown, Centerport, Douglassville, Earlville, Fleetwood, Geigertown, Hamburg, Kempton, Kutztown, Leesport, Lenhartsville, Limekiln, Lyon Station, Maxatawny, Mertztown, Mohnton, Mohrsville, Monocacy Station, Morgantown, Mount Aetna, New Berlinville, Oley, Pine Forge, Rehrersburg, Robesonia, Shartlesville, Shoemakersville, Strausstown, Temple, Topton, Virginville, Wernersville, Womelsdorf, Reading, and all other areas of Berks County, Pennsylvania; Medicare plans are the same throughout the County.