Humana Gold Plus Giveback H1036-269 (HMO)
Monthly premium
$0.00
CMS Plan Rating
Contract ID
★★★★
★
H1036-269-000
Medical deductible
$0
Rx deductible
$0
Medicare Part B Giveback
$155.00
Monthly premium
$0.00
Humana Gold Plus Giveback H1036-269 (HMO)
Contract ID
CMS Plan Rating
H1036-269-000
★★★★
★
Medical deductible
$0
Rx deductible
$0
Medicare Part B Giveback
$155.00
Medicare Advantage, also known as Medicare Part C, is a health plan option that provides Medicare Part A and Part B coverage. Medicare Advantage plans are offered by private insurance companies that are approved by Medicare. These plans provide benefits similar to Original Medicare Part A and Part B, but often include additional benefits such as dental, hearing and vision.
Medical benefits
In-network
What you pay
Primary doctor
$0 copay
Specialist
$15 copay
Outpatient diagnostic tests/Lab and X-Rays
$0 - 20% coinsurance
Urgent care
$15 copay
Maximum Out-of-Pocket (Annually)
$3,200 in-network
Ambulance services
$240 copay
Emergency room (waived if admitted to hospital within 24 hours)
$150 copay
Inpatient hospital care
$135 copay per day (Days 1-6)
Skilled nursing facility
$0 copay per day (Days 1-20)
- Important Notice
For full plan details, see the Evidence of Coverage or Summary of Benefits in the Plan Documents.
Rx benefits
Tier 1 - Preferred generic
$0 copay
Tier 2 - Generic
$0 copay
Tier 3 - Preferred brand
$30 copay
Tier 4 - Non-preferred brand
35%
Tier 5 - Specialty
33%
Additional Benefits
- Vision
- Dental
- Hearing
- SilverSneakers Gym Membership
- Worldwide Emergency Coverage