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Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP)

Humana Inc.
Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) H4007-031 Plan Details
4 out of 5 stars

Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H4007-031

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.

$0.00
Monthly Premium

Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H4007-031

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 SNP-DE H4007-031 (HMO D-SNP) H4007-031 Plan Details
4 out of 5 stars

Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H4007-031

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.

$0.00
Monthly Premium

Puerto Rico Counties Served

Quebradillas Coamo Aguadilla Utuado Rincon Orocovis Patillas Arecibo Camuy Penuelas Florida Las Marias Manati Aibonito Salinas Cidra Culebra Bayamon Aguada Maricao Cabo Rojo Lajas Adjuntas Anasco Barceloneta Guanica Sabana Grande Lares Isabela Naguabo Canovanas Villalba San German Guayanilla Aguas Buenas Cayey San Lorenzo Las Piedras Juncos Guayama Comerio Hormigueros Vega Baja Morovis Maunabo Humacao Vieques Toa Alta Ciales Hatillo Dorado Jayuya Yauco Loiza Toa Baja Mayaguez Moca San Sebastian Fajardo Barranquitas Vega Alta Arroyo Naranjito Rio Grande Caguas Ceiba Santa Isabel Yabucoa Ponce San Juan Trujillo Alto Luquillo Gurabo Juana Diaz Corozal Guaynabo Catano Carolina

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $3400
Out-of-Network: N/A
Initial Coverage Limit $2000
Catastrophic Coverage Limit $2,000
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $0
Referral Required for Doctor Specialty Visit
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
Copayment for Acute Hospital Services per Stay $0
Prior Authorization Required for Acute Hospital Services
Prior authorization required
Urgent Care
Copayment for Urgent Care $0

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $0
Emergency Room Visit
Copayment for Emergency Care $0

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $0
Copayment for Worldwide Emergency Transportation $0
Ambulance Transportation
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $0

Air Ambulance:
Copayment for Air Ambulance Services $0
Prior Authorization Required for Air Ambulance
Prior authorization required

Health Care Services and Medical Supplies

Humana Gold Plus SNP-DE H4007-031 (HMO D-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:
Copayment for Medicare-covered Chiropractic Services $0
Copayment for Routine Care $0
  • Maximum 12 Routine Care every year
Referral Required for Chiropractic Services
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Copayment for Medicare-covered Diabetic Supplies $0
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0
Durable Medical Eqipment (DME)
In-Network:
Copayment for Medicare-covered Durable Medical Equipment $0 or 0
Coinsurance for Medicare-covered Durable Medical Equipment 0 or 10%
Prior Authorization Required for Durable Medical Equipment
10% Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy10% DME - DME Prov10% DME - Pharmacy_
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
Copayment for Medicare-covered Lab Services $0
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
Referral Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $0
Copayment for Medicare-covered Therapeutic Radiological Services $0
Copayment for Medicare-covered X-Ray Services $0
Prior authorization required
Home Health Care
In-Network:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Prior authorization required
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
Copayment for Psychiatric Hospital Services per Stay $0
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Mental Health Outpatient Care
In-Network:
Copayment for Medicare-covered Individual Sessions $0
Copayment for Medicare-covered Group Sessions $0
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per stay $0
Prior Authorization Required for Outpatient Observation Services

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0
Prior Authorization Required for Ambulatory Surgical Center Services
Prior authorization required
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $0
Copayment for Medicare-covered Group Sessions $0
Over-the-counter (OTC) Items
In-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0
  • Maximum plan benefit of $1620 every year for Over-The-Counter (OTC) Items
Maximum Plan Benefit of $1,620 every year
The plan will provide 1 blood pressure monitoring unit every 5 years for members who meet the medical criteria.
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $0
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
Copayment for Skilled Nursing Facility Services per Stay $0
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
0% coinsurance for periodontal surgery up to 1 per quadrant every 3 years.
0% coinsurance for amalgam or composite filling up to 1 per tooth every 3 years.
0% coinsurance for comprehensive oral exam, cone beam CT imaging, panoramic film up to 1 every 3 years.
0% coinsurance for crown up to 1 per tooth every 5 years.
0% coinsurance for bridges, complete dentures, complete or partial denture reline, partial dentures up to 1 every 5 years.
0% coinsurance for other restorative services - core buildup and prefabricated post and core up to 1 per tooth per lifetime.
0% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant per year.
0% coinsurance for bitewing x-rays up to 1 set(s) per year.
0% coinsurance for periodontal debridement up to 1 per year.
0% coinsurance for pulp vitality test up to 2 per quadrant per year.
0% coinsurance for periodic oral exam, periodontal maintenance, prophylaxis (cleaning) up to 2 per year.
0% coinsurance for complete or partial denture repair up to 3 per year.
0% coinsurance for intraoral x-rays up to 6 per year.
0% coinsurance for adjustments to dentures, extractions, root canal up to unlimited per year.
$1,000 maximum benefit coverage amount per year for adjustments to dentures, bridges, complete dentures, complete or partial denture reline, complete or partial denture repair, crown, other restorative services - core buildup and prefabricated post and core, partial dentures comprehensive benefits.

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
Copayment for Routine Eye Exams $0
  • Maximum 1 Routine Eye Exam every year

Eyewear:
Copayment for Medicare-Covered Benefits $0
Copayment for Contact Lenses $0
Copayment for Eyeglasses (lenses and frames) $0
Maximum Plan Benefit of $200 every year

Hearing Benefits

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

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $0
Copayment for Routine Hearing Exams $0
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0
  • Maximum 1 visit every year

Hearing Aids:
Maximum Plan Allowance of $1,000 every year

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
    • Tobacco use cessation
    Yearly "Wellness" visit
    Back to Plans in Puerto Rico