Florida Medicare Advantage Plan (2024 Plan)
Monthly Premium
Your Cost
$0
by Humana
Additional Coverage
HearingVisionDental
Overall Government Star Rating
5.0
out of 5 stars
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Plan Overview
Plan Name
Humana Gold Plus H1036-025 (HMO)
Insurance Carrier
Humana
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO
Humana Gold Plus H1036-025 (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Florida and offered by the health insurance company Humana. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$1,800
Primary doctor visit
$0 copay
Specialist visit
$5 copay per visit
ER visit
$85 copay per visit (always covered)
Ambulance
$150 copay
Humana Gold Plus H1036-025 (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $1,800 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Humana Gold Plus H1036-025 (HMO) are defined below.
Additional Benefits and Coverage
Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing
Humana Gold Plus H1036-025 (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Humana Gold Plus H1036-025 (HMO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Humana Gold Plus H1036-025 (HMO) includes coverage for the following additional benefits:
Other benefits
Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Limited coverage
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage
Comparing the Quality Score of Humana Gold Plus (HMO) to Other Plans in Florida
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Humana Gold Plus (HMO) received an overall government quality rating of 5.0 stars out of 5 stars.
Humana Gold Plus (HMO) performed better than Florida’s State average overall quality score of 4.4 stars.
This Plan’s 5-star Gov’t Quality Score
Florida State Average Score
Overall Government 5 Star Quality Rating
5.0
4.4
Summary rating of health plan quality
4.5
4.3
Staying healthy: screenings, tests, & vaccines
4
4.0
Managing chronic (long term) conditions
4
4.0
Member experience with health plan
4
3.8
Member complaints & changes in the health plan's performance
4
4.1
Health plan customer service
5
4.6
Summary rating of drug plan quality
4.5
4.2
Drug plan customer service
5
3.9
Member complaints & changes in the drug plan's performance
4
4.0
Member experience with the drug plan
5
4.4
Drug safety & accuracy of drug pricing
4
3.8
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Humana Gold Plus (HMO) received 4.5 stars for its health plan quality score which is better than the Florida State average health plan quality score of 4.3 stars.
Humana Gold Plus (HMO) received 4.5 stars for its drug plan quality score which is better than the Florida State average drug plan quality score of 4.2 stars.
Plan Benefits and Coverage Details
Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$1,800 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
Plan Link
Medical Benefits
Doctor Services
Primary doctor visit
$0 copay
Specialist visit
$5 copay per visit
Tests, labs, & imaging
Diagnostic tests & procedures
$0-25 copay
Lab services
$0-20 copay
Diagnostic radiology services (like MRI)
$0-85 copay
Outpatient x-rays
$0-20 copay
Emergency care
$85 copay per visit (always covered)
Urgent care
$5 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
$75 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 90 and beyond
Outpatient hospital coverage
$0-85 copay per visit
Skilled nursing facility
Skilled nursing facility
$0 per day for days 1 through 20
$150 per day for days 21 through 100
Preventive services
Preventive services
$0 copay
Ambulance
Ground ambulance
$150 copay
Therapy services
Occupational therapy visit
$5-15 copay
Physical therapy & speech & language therapy visit
$5-15 copay
Mental health services
Outpatient group therapy with a psychiatrist
$5 copay
Outpatient individual therapy with a psychiatrist
$5 copay
Outpatient group therapy visit
$5 copay
Outpatient individual therapy visit
$5 copay
Opioid treatment services
Opioid treatment services
Covered
Other services
Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
$0 copay
Diabetes supplies
$0 copay or 20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
Brand-name drugs : |
| Generic | $0.00 copay | $0.00 copay | |
| Preferred Brand | $5.00 copay | ||
| Non-Preferred Drug | $55.00 copay | ||
| Specialty Tier | 33% | ||
| 1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. | |||
Part B Drugs
Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance
Extra Benefits
Hearing
Hearing exam
$5 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$199-1,299 copay
Preventive Dental
Oral exam
$0 copay
Cleaning
$0 copay
Fluoride treatment
$0 copay
Dental x-rays
$0 copay
Comprehensive dental
Non-routine services
$0 copay
Diagnostic services
$0 copay
Restorative services
$0 copay
Endodontics
$0 copay
Periodontics
$0 copay
Extractions
$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
$0 copay
Vision
Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered
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