Post discharge In-Home Medication Reconciliation: Not covered.Medical Nutrition Therapy (MNT): Not covered.Personal Emergency Response System (PERS): Not covered.WorldWide emergency urgent care: Some coverage.WorldWide emergency coverage: Some coverage.WorldWide emergency transportation: Some coverage.Meals for short duration: Some coverage.Over-the-counter drug benefits: Some coverage.Medically-approved non-opioid pain management services Eyeglasses (frames and lenses): $0 copay (limits apply, authorization required).Contact lenses: $0 copay (limits apply, authorization required).Routine eye exam: $0 copay (limits apply, authorization required).Prosthodontics, other oral/maxillofacial surgery, other services: Not covered.Periodontics: 0% coinsurance (limits apply, authorization required).Restorative services: 0% coinsurance (limits apply, authorization required).Dental x-ray(s): $0 copay (limits apply).Fluoride treatment: $0 copay (limits apply).Hearing aids: $399-699 copay (limits apply).Fitting/evaluation: $0 copay (authorization required).Hearing exam: $25 copay (authorization required).20% coinsurance (authorization required).Diabetes supplies: $0 copay or 10-20% coinsurance per item (authorization required).Prosthetics (e.g., braces, artificial limbs): 20% coinsurance per item (authorization required).Durable medical equipment (e.g., wheelchairs, oxygen): 20% coinsurance per item (authorization required).In-network: $25.00 copay (authorization required).Outpatient individual therapy visit: $25 copay (authorization required).Outpatient group therapy visit: $25 copay (authorization required).Outpatient individual therapy visit with a psychiatrist: $25 copay (authorization required).Outpatient group therapy visit with a psychiatrist: $25 copay (authorization required).$0 per day for days 6 through 90 (authorization required) Inpatient hospital - psychiatric: $175 per day for days 1 through 5.Physical therapy and speech and language therapy visit: $20 copay (authorization required).Occupational therapy visit: $20 copay (authorization required).$188 per day for days 21 through 100 (authorization required) $25-175 copay per visit (authorization required).$0 per day for days 91 and beyond (authorization required) Urgent care: $0-25 copay per visit (always covered).Emergency: $90 copay per visit (always covered).Outpatient x-rays: $0-25 copay (authorization required).Diagnostic radiology services (e.g., MRI): $25-250 copay (authorization required).Lab services: $0-25 copay (authorization required).Diagnostic tests and procedures: $0-100 copay (authorization required).Specialist: $25 copay per visit (authorization required)ĭiagnostic procedures/lab services/imaging.Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)Īdditional benefits and/or reduced cost-sharing for enrollees with certain health conditions? Drug plan deductible: No annual deductible.Other health plan deductibles: In-network: No.You must continue to pay your Part B premium.Total Monthly Premium with LIS (Parts C & D): Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ The Monthly Premium is Split as Follows: ❔ This plan qualifies for the 5-star rating Special Enrollment period. Number of Members enrolled in this plan in (H4461 - 031): Number of Members enrolled in this plan in Tennessee: Number of Members enrolled in this plan in Scott, Tennessee: This plan offers select insulin at a $35 copay. See cost-sharing for all pharmacies and tiers. No additional gap coverage, only the Donut Hole Discountīrowse the Humana Gold Plus H4461-031 (HMO) Formulary ![]() ![]() Maximum Out-of-Pocket Limit for Parts A & B (MOOP): ET.Įmail a copy of the Humana Gold Plus H4461-031 (HMO) benefit details Find a 2022 Medicare Advantage Plan by Drug CostsĬompare and enroll in your Medicare plan with help from licensed agents.Ĭall 83/ TTY: 711, Mon‐Fri 9 a.m.-8 p.m.2022 Medicare Advantage Plan Benefit Details.2022 Medicare Advantage Plans State Overview.IRMAA: Higher premiums for higher incomes.Understanding Your Explanation of Benefits.Medicare plan quality and CMS Star Ratings.Q1Rx Drug-Finder: Compare Drug Cost Across all 2022 Medicare Plans.Browse Any 2022 Medicare Plan Formulary (or Drug List).Find a 2022 Medicare Advantage Plan (Health and Health w/Rx Plans).
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