- HumanaOne Dental Preventive Plus This dental PPO plan offers low deductibles, no copayments, and provides 100% coverage for many preventive procedures. This plan does not require a dentist selection. HumanaOne Dental Value plan (C550 and HI215).
- Acute inpatient hospital care $295 copay per day for days 1-6 $0 copay per day for days 7-90 Your plan covers an unlimited number of days for an inpatient stay.
- Individual and family dental insurance plans From budget-friendly monthly premiums to low office-visit copays, Humana has a dental plan that is sure to fit your needs. View plans and prices available in your area.
But if a $100 toothache turns into a $1,000 root canal, a supplemental dental plan from Humana can help. Our dental plans offer coverage ranging from help with your basic dental needs such as routine cleanings and exams, X-rays and fillings, to more serious procedures including extractions, root.
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Humana Gold Plus H4461-036 (HMO-POS) H4461-036 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Humana available to residents in Tennessee. This plan includes additional Medicare prescription drug (Part-D) coverage. The Humana Gold Plus H4461-036 (HMO-POS) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $5,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,900 out of pocket. This can be a extremely nice safety net.
Humana Gold Plus H4461-036 (HMO-POS) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Gold Plus H4461-036 (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2021 Humana Medicare Advantage Plan Costs
| Name: |
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| Plan ID: | H4461-036 |
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| Provider: | Humana |
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| Year: | 2021 |
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| Type: | Local HMO |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: | $0 |
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| MOOP: | $5,900 |
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| Part D (Drug) Premium: | $0 |
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| Part D Supplemental Premium | $0 |
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| Total Part D Premium: | $0 |
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| Drug Deductible: | $0 |
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| Tiers with No Deductible: | 0 |
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| Gap Coverage: | No |
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| Benchmark: | not below the regional benchmark |
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| Type of Medicare Health: | Enhanced Alternative |
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| Drug Benefit Type: | Enhanced |
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| Similar Plan: | H4461-037 |
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Humana Gold Plus H4461-036 (HMO-POS) Part-C Premium
Humana plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H4461-036 Part-D Deductible and Premium
Humana Gold Plus H4461-036 (HMO-POS) has a monthly drug premium of $0 and a $0 drug deductible. This Humana plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Humana above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Humana Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Humana plan does not offer additional coverage through the gap.
H4461-036 Formulary or Drug Coverage
Humana Gold Plus H4461-036 (HMO-POS) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 Humana Gold Plus H4461-036 (HMO-POS) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | Not covered |
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| Endodontics | Not covered |
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| Extractions | 55% coinsurance (Out-of-Network) |
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| Extractions | 0% coinsurance |
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| Non-routine services | Not covered |
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| Periodontics | Not covered |
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| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
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| Restorative services | 55% coinsurance (Out-of-Network) |
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| Restorative services | 0% coinsurance |
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Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $35-295 copay |
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| Diagnostic tests and procedures | $0-100 copay |
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| Lab services | $0-35 copay |
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| Outpatient x-rays | $0-35 copay |
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Doctor Visits
| Primary | $0 copay |
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| Specialist | $35 copay per visit |
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Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $0-35 copay per visit (always covered) |
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Foot Care (podiatry services)
| Foot exams and treatment | $35 copay |
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| Routine foot care | Not covered |
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Ground Ambulance
Hearing
| Fitting/evaluation | $0 copay |
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| Hearing aids | $399-699 copay |
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| Hearing exam | $35 copay |
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Inpatient Hospital Coverage
| Not Applicable (Out-of-Network) |
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$295 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond |
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Medical Equipment/Supplies
| Diabetes supplies | $0 copay or 10-20% coinsurance per item |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
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| Other Part B drugs | 20% coinsurance |
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Mental Health Services
| Inpatient hospital - psychiatric | Not Applicable (Out-of-Network) |
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| Inpatient hospital - psychiatric | $295 per day for days 1 through 6
$0 per day for days 7 through 90 |
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| Outpatient group therapy visit | $35 copay |
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| Outpatient group therapy visit with a psychiatrist | $35 copay |
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| Outpatient individual therapy visit | $35 copay |
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| Outpatient individual therapy visit with a psychiatrist | $35 copay |
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MOOP
Option
Optional supplemental benefits
Outpatient Hospital Coverage
Preventive Care
Preventive Dental
| Cleaning | $0 copay |
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| Cleaning | $0 copay (Out-of-Network) |
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| Dental x-ray(s) | $0 copay |
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| Dental x-ray(s) | $0 copay (Out-of-Network) |
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| Fluoride treatment | Not covered |
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| Oral exam | $0 copay (Out-of-Network) |
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| Oral exam | $0 copay |
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Rehabilitation Services
| Occupational therapy visit | $25 copay |
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| Physical therapy and speech and language therapy visit | $25 copay |
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Skilled Nursing Facility
| Not Applicable (Out-of-Network) |
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$0 per day for days 1 through 20
$184 per day for days 21 through 100 |
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Transportation
Vision
| Contact lenses | $0 copay |
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| Eyeglass frames | Not covered |
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| Eyeglass lenses | Not covered |
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| Eyeglasses (frames and lenses) | $0 copay |
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| Other | Not covered |
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| Routine eye exam | $0 copay |
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| Upgrades | Not covered |
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Wellness Programs (e.g. fitness nursing hotline)
Reviews for Humana Gold Plus H4461-036 (HMO-POS) H4461
| 2019 Overall Rating |
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| Part C Summary Rating |
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| Part D Summary Rating |
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| Staying Healthy: Screenings, Tests, Vaccines |
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| Managing Chronic (Long Term) Conditions |
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| Member Experience with Health Plan |
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| Complaints and Changes in Plans Performance |
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| Health Plan Customer Service |
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| Drug Plan Customer Service |
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| Complaints and Changes in the Drug Plan |
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| Member Experience with the Drug Plan |
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| Drug Safety and Accuracy of Drug Pricing |
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Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
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| Breast Cancer Screening |
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| Colorectal Cancer Screening |
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| Annual Flu Vaccine |
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| Improving Physical |
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| Improving Mental Health |
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| Monitoring Physical Activity |
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| Adult BMI Assessment |
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Managing Chronic And Long Term Care for Older Adults
| Total Rating |
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| SNP Care Management |
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| Medication Review |
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| Functional Status Assessment |
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| Pain Screening |
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| Osteoporosis Management |
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| Diabetes Care - Eye Exam |
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| Diabetes Care - Kidney Disease |
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| Diabetes Care - Blood Sugar |
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| Rheumatoid Arthritis |
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| Reducing Risk of Falling |
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| Improving Bladder Control |
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| Medication Reconciliation |
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| Statin Therapy |
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Member Experience with Health Plan
| Total Experience Rating |
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| Getting Needed Care |
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| Customer Service |
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| Health Care Quality |
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| Rating of Health Plan |
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| Care Coordination |
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Member Complaints and Changes in Humana Gold Plus H4461-036 (HMO-POS) Plans Performance
| Total Rating |
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| Complaints about Health Plan |
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| Members Leaving the Plan |
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| Health Plan Quality Improvement |
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| Timely Decisions About Appeals |
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Health Plan Customer Service Rating for Humana Gold Plus H4461-036 (HMO-POS)
| Total Customer Service Rating |
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| Reviewing Appeals Decisions |
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| Call Center, TTY, Foreign Language |
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Humana Gold Plus H4461-036 (HMO-POS) Drug Plan Customer Service Ratings
| Total Rating |
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| Call Center, TTY, Foreign Language |
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| Appeals Auto |
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| Appeals Upheld |
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Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
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| Complaints about the Drug Plan |
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| Members Choosing to Leave the Plan |
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| Drug Plan Quality Improvement |
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Member Experience with the Drug Plan
| Total Rating |
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| Rating of Drug Plan |
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| Getting Needed Prescription Drugs |
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Drug Safety and Accuracy of Drug Pricing
| Total Rating |
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| MPF Price Accuracy |
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| Drug Adherence for Diabetes Medications |
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| Drug Adherence for Hypertension (RAS antagonists) |
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| Drug Adherence for Cholesterol (Statins) |
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| MTM Program Completion Rate for CMR |
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| Statin with Diabetes |
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How Much Does Humana Dental Cost
What Is Covered Under Humana Dental
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Humana Gold Plus H4461-036 (HMO-POS)
(Click county to compare all available Advantage plans)
| State: | Tennessee
|
|---|
| County: | Bledsoe,Bradley,Franklin,Grundy,Hamilton,
Marion,McMinn,Meigs,Polk,
Rhea,Sequatchie, |
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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
Humana Gold Plus® is a Medicare Advantage Health Maintenance Organization (HMO) plan with a wide range of coverage for seniors. Humana has contracted with Medicare to provide you with services that are not covered by your Medicare Part A and Part B benefits under original Medicare. Most Medicare Advantage Humana Gold Plus HMO Plans offer prescription drug coverage. With Gold Plus HMO Plans your out-of-pocket costs are reduced and more predictable than with the majority of other plans. You may enroll in Gold Plus HMO plan only during specific times of the year. You can compare this to Humana’s Gold Choice PFFs, Humana’s Part D Drug Plans, HumanaChoice PPO and Humana Enhanced PDP. Below is an example of one of the many plans offered by Humana.
Summary
| Plan Type | Humana Gold Plus H1951-013 (HMO) |
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| Office Visit for Primary Doctor | $10 copay for each primary care doctor visit for Medicare-covered benefits. |
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| Office Visit for Specialist | $10 to $25 copay for each specialist visit for Medicare-covered benefits. |
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| Doctor Choice | Plan Doctor Only |
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| Annual Deductible | None |
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| Out-of-Pocket Maximum | $4,900 |
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| Prescription Drug Coverage | Yes |
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| Physical Exams | $0 copay for all preventive services covered under Original Medicare at zero cost sharing. |
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Hospital Services Coverage
| Emergency Room | $65 copay for Medicare-covered emergency room visits. $25,000 plan coverage limit for emergency services outside the U.S. every year. |
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| Ambulance Services | $200 copay for Florida Medicare-covered ambulance benefits. |
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| Outpatient Lab/X-Ray | $0 to $25 copay for Medicare-covered lab services. $0 to $50 copay for Medicare-covered diagnostic procedures and tests. $10 to $50 copay for Medicare-covered X-rays. |
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| Outpatient Surgery | $250 copay for each Medicare-covered ambulatory surgical center visit. $0 to $250 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit. |
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| Urgent Care | $10 to $25 copay for Medicare-covered urgently needed care visits. |
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| Hospitalization | No limit to the number of days covered by the plan each hospital stay. For Medicare-covered hospital stays: Days 1 – 7: $175 copay per day; Days 8 – 90: $0 copay per day; $0 copay for each additional hospital day. |
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| Outpatient Rehabilitation Services | $10 copay for Medicare-covered Occupational Therapy visits. $10 copay for Medicare-covered Physical and/or Speech and Language Therapy visits. |
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| Skilled Nursing Facility | Plan covers up to 100 days each benefit period; No prior hospital stay is required. For SNF stays: Days 1 – 5: $0 copay per day; Days 6 – 20: $50 copay per day; Days 21 – 100: $100 copay per day. |
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| Home Health Care | $0 copay for each Medicare-covered home health visit. |
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| Hospice | You must get care from a Medicare-certified hospice. |
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Retail Pharmacy for Prescription Drugs
| Prescription Drug Deductible | None |
|---|
| Preferred Generic | You pay the following until total yearly drug costs reach $2,930: – $6 copay for a one-month (30-day) supply of drugs in this tier; – $18 copay for a three-month (90-day) supply of drugs in this tier. |
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| Non-Preferred Generic | You pay the following until total yearly drug costs reach $2,930: – $10 copay for a one-month (30-day) supply of drugs in this tier; – $30 copay for a three-month (90-day) supply of drugs in this tier. |
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| Preferred Brand | You pay the following until total yearly drug costs reach $2,930: – $45 copay for a one-month (30-day) supply of drugs in this tier; – $135 copay for a three-month (90-day) supply of drugs in this tier. |
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| Non-Preferred Brand | You pay the following until total yearly drug costs reach $2,930: – $95 copay for a one-month (30-day) supply of drugs in this tier; – $285 copay for a three-month (90-day) supply of drugs in this tier. |
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| Specialty | 33% coinsurance for a one-month (30-day) supply of drugs in this tier. |
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Mail Order Pharmacy for Prescription Drugs
What Does My Humana Dental Plan Cover
| Preferred Generic | You pay the following until total yearly drug costs reach $2,930: – $0 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy; – $0 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy. |
|---|
| Non-Preferred Generic | You pay the following until total yearly drug costs reach $2,930: – $0 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy; – $0 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy. |
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| Preferred Brand | You pay the following until total yearly drug costs reach $2,930: – $45 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy; – $125 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy. |
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| Non-Preferred Brand | You pay the following until total yearly drug costs reach $2,930: – $95 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy; – $275 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy. |
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| Specialty | 33% coinsurance for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy. |
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Additional Coverage
Humana Medicare Ppo Dental Plans
How To Pay Humana Dental Online
| Dental Services | $0 copay for the following preventive dental benefits: – $0 copay for up to 1 oral exam(s) every year; – $0 copay for up to 1 cleaning(s) every year; – $0 copay for up to 1 dental x-ray(s) every year. $25 copay for Medicare-covered dental benefits. |
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| Hearing Services | In general, routine hearing exams and hearing aids not covered. – $25 copay for Medicare-covered diagnostic hearing exams. |
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| Vision Services | $0 copay for one pair of eyeglasses or contact lenses after cataract surgery. – $0 to $25 copay for exams to diagnose and treat diseases and conditions of the eye. – $0 copay for up to 1 supplemental routine eye exam(s) every year. |
|---|
| Chiropractic Coverage | $20 copay for each Medicare-covered visit. Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers. |
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| Outpatient Mental Health Coverage | $25 copay for each Medicare-covered individual therapy visit, $25 copay for each Medicare-covered group therapy visit, $25 copay for each Medicare-covered individual therapy visit with a psychiatrist, $25 copay for each Medicare-covered group therapy visit with a psychiatrist, $25 copay for the cost for Medicare-covered partial hospitalization program services. |
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