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Humana Gold Plus - Diabetes and Heart (HMO C-SNP)

Humana Inc.
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) H5619-160 Plan Details
4 out of 5 stars

Humana Gold Plus - Diabetes and Heart (HMO C-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5619-160

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$25.80
Monthly Premium

Humana Gold Plus - Diabetes and Heart (HMO C-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5619-160

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Humana Inc.
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) H5619-160 Plan Details
4 out of 5 stars

Humana Gold Plus - Diabetes and Heart (HMO C-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5619-160

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$25.80
Monthly Premium

Indiana Counties Served

Marion Fulton Tipton Brown Steuben Union Parke Ohio Orange Crawford Switzerland Fountain Carroll Vanderburgh Franklin Warren Lake Martin Owen Benton

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $545
Out of Pocket Max In-Network: $8850
Out-of-Network: N/A
Initial Coverage Limit $0
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0.00
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Coinsurance for Physician Specialist Office Visit 20.00%
Prior Authorization Required for Doctor Specialty Visit
Prior authorization required
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$569.00 per day for days 1 to 4
$0.00 per day for days 5 to 90
Prior Authorization Required for Acute Hospital Services
Prior authorization required
Urgent Care
Coinsurance for Urgent Care 20.00%

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $100.00
Emergency Room Visit
Copayment for Emergency Care $100.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $100.00
Copayment for Worldwide Emergency Transportation $100.00

Health Care Services and Medical Supplies

Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Coinsurance for Medicare-covered Chiropractic Services 20.00%
Prior Authorization Required for Chiropractic Services
Prior authorization required
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Copayment for Medicare-covered Diabetic Supplies $0.00
Coinsurance for Medicare-covered Diabetic Supplies 20.00%
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0.00
Prior Authorization Required for Diabetic Supplies and Services
Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage)
Prior authorization required
Durable Medical Eqipment (DME)
In-Network:
Coinsurance for Medicare-covered Durable Medical Equipment 20.00%
Prior Authorization Required for Durable Medical Equipment
Prior authorization required
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0.00
Coinsurance for Medicare-covered Diagnostic Procedures/Tests 20.00%
Copayment for Medicare-covered Lab Services $0.00
Coinsurance for Medicare-covered Lab Services 20.00%
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Coinsurance for Medicare-covered Diagnostic Radiological Services 20.00%
Coinsurance for Medicare-covered Therapeutic Radiological Services 20.00%
Copayment for Medicare-covered X-Ray Services $0.00
Coinsurance for Medicare-covered X-Ray Services 20.00%
Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services
Prior authorization required
Home Health Care
In-Network:
Copayment for Medicare-covered Home Health Services $0.00
Prior Authorization Required for Home Health Services
Please see Evidence of Coverage for Additional Home Health Benefits
Prior authorization required
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$484.00 per day for days 1 to 4
$0.00 per day for days 5 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Mental Health Outpatient Care
In-Network:
Coinsurance for Medicare-covered Individual Sessions 20.00%
Coinsurance for Medicare-covered Group Sessions 20.00%
Prior Authorization Required for Outpatient Mental Health Services
Prior authorization required
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Coinsurance for Medicare Covered Outpatient Hospital Services 20.00%
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services $350.00
Prior Authorization Required for Outpatient Observation Services

Ambulatory Surgical Center Services:
Coinsurance for Ambulatory Surgical Center Services 20.00%
Prior Authorization Required for Ambulatory Surgical Center Services
Prior authorization required
Outpatient Substance Abuse Care
In-Network:
Coinsurance for Medicare-covered Individual Sessions 20.00%
Coinsurance for Medicare-covered Group Sessions 20.00%
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Over-the-counter (OTC) Items
In-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $300.00 every three months
Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit
Podiatry Services
In-Network:
Coinsurance for Medicare-Covered Podiatry Services 20.00%
Copayment for Routine Foot Care $0.00
  • Maximum 6 visits every year
Prior Authorization Required for Podiatry Services
Prior authorization required
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0.00 per day for days 1 to 100
Prior Authorization Required for Skilled Nursing Facility Services
Prior authorization required

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:

Preventive Dental:
Copayment for Oral Exams $0.00
  • Maximum 3 visits every year
Copayment for Prophylaxis (Cleaning) $0.00
  • Maximum 6 visits every year
Copayment for Fluoride Treatment $0.00
  • Maximum 2 visits every year
Copayment for Dental X-Rays $0.00
  • Maximum 3 visits (Please see Evidence of Coverage for details)
Maximum Plan Benefit of $3000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined

Comprehensive Dental:
Coinsurance for Medicare-covered Benefits 20.00%
Copayment for Non-routine Services $0.00
  • Maximum 2 visits every year
Copayment for Diagnostic Services $0.00
  • Maximum 1 visit every three years
Copayment for Restorative Services $0.00
  • Maximum 4 visits (Please see Evidence of Coverage for details)
Copayment for Endodontics $0.00
  • Maximum 2 visits (Please see Evidence of Coverage for details)
Copayment for Periodontics $0.00
  • Maximum 2 visits every three years
Copayment for Extractions $0.00
Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00
  • Maximum 6 visits (Please see Evidence of Coverage for details)
Maximum Plan Benefit of $3000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined
Prior Authorization Required for Comprehensive Dental
Prior authorization required

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0.00
Coinsurance for Medicare Covered Benefits 20.00%
Copayment for Routine Eye Exams $0.00
  • Maximum 1 Routine Eye Exams every year
Prior Authorization Required for Eye Exams

Eyewear:
Copayment for Medicare-Covered Benefits $0.00
Copayment for Contact Lenses $0.00
  • Maximum 1 Pair every year
Copayment for Eyeglasses (lenses and frames) $0.00
  • Maximum 1 Pair every year
Maximum Plan Benefit of $350.00 every year for all Non-Medicare covered eyewear
Prior Authorization Required for Eyewear
Prior authorization required

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Coinsurance for Medicare Covered Benefits 20.00%
Copayment for Routine Hearing Exams $0.00
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0.00
Prior Authorization Required for Hearing Exams

Hearing Aids:
Copayment for Hearing Aids $0.00 to $299.00
  • Maximum 2 Hearing Aids every three years

Prior authorization required
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