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.
Humana Gold Choice H8145-052's monthly premium in Berks County is $74.00. That includes your prescription coverage, 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).
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 Humana Gold Choice H8145-052, 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
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.
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. To learn more about this plan, visit the Humana Medicare website.
Additional Medicare 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:
- AmeriHealth Caritas VIP Care (Local HMO), for Dual-Eligible beneficiaries
- BlueJourney Alliance Heart and Diabetes Care (Local HMO), for Chronic or Disabling Condition beneficiaries
- UnitedHealthcare Nursing Home Plan 2 (Local PPO), for Institutional beneficiaries
- Gateway Health Medicare Assured Diamond (Local HMO), for Dual-Eligible beneficiaries
- UPMC for Life Dual (Local HMO), for Dual-Eligible beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- Aetna Medicare Premier Plus (PPO)
- Aetna Medicare Advantra Silver Plus (PPO)
- Community Blue Medicare PPO Distinct (PPO)
- Health Partners Medicare Simple (HMO-POS)
- Humana Honor (PPO)