Humana Copay Plans

Humana Copay Plans 2020
Humana Copay Plans
Humana Copay Plans Online

NOTE: Medigap, Medicare Supplements, and Medicare Plans are all names used interchangeably for supplemental insurance that fills the gaps (i.e., copay, coinsurance, and other major medical expenses) in Original Medicare coverage. Each Medicare supplement insurance policy sold in California offers the basic benefits of Plan A. Want an exact price for your co-pay? Select Your Plan. Ways to Save on Shingrix. Here are some ways that may lower the cost of your Shingrix prescription. Instead of Medicare, Use a Coupon. If your Medicare co-pay is higher than $155.00, you can save money by using a GoodRx coupon instead.

October 27, 2020

ANSWERS TO COMMON QUESTIONS
ABOUT INSURANCE PLANS AND MDLIVE.

For many of us, insurance is confusing. In fact, 27% of Americans say they avoid care or treatment because of confusion about insurance.*

Understanding your benefits and if MDLIVE is included in them is important to know when you seek care.

MDLIVE accepts many types of insurance from major providers like Cigna, Blue Cross, Blue Shield, Humana, and many others. More than 60 million people have MDLIVE as part of their health insurance benefit!

MDLIVE is here to help. Our insurance FAQ is designed to answer common insurance questions and help you be prepared when you need care.

More than 60 million people have MDLIVE
as part of their health insurance benefit.

MDLIVE accepts most insurance plans, but it depends on the specific insurance plan you have. To find out if we accept your insurance, you can sign in to your MDLIVE account or register for a free account in about 90 seconds.

Yes, you can have a virtual doctor visit with MDLIVE – even if you don’t have insurance. We will 0003always show you the cost of your visit before it begins. Please note, the price you pay without 0003insurance or if your plan is not in the MDLIVE network will usually be higher than an insurance copay but may be less expensive than Urgent Care Clinic or Emergency Room visits.

If MDLIVE accepts your insurance, the MDLIVE visit fee for you and your eligible dependents 0003will typically be covered according to the details of your benefit plan. We will show you your out-of-pocket visit cost whenever that information is available to minimize surprise costs. Many insurance plans also cover prescriptions and diagnostic tests ordered by a physician0003during a virtual visit. Consult your insurance plan for details.

A copay is a flat fee you pay for specific medical services – usually doctor visits or prescription 0003drugs – often regardless of whether you have hit your deductible. Copays are shown as a dollar amount. For example, “$10 copay per visit” or “$5 copay for generic medications.” For MDLIVE 0003visits, your copay, if any, will be displayed before your visit starts.

Many High Deductible Health Plans (HDHP) use coinsurance instead of copays for doctor visits. 0003Coinsurance is the portion of covered medical expenses you can expect to pay out-of-pocket after you have hit your deductible. Your insurance plan pays the remainder of the bill. Coinsurance 0003is shown as a percentage. For example, if you have reached your deductible and have 20% 0003coinsurance, you would pay $10 out-of-pocket for a visit that costs $50.

An annual deductible is an amount you’re responsible for paying each year for covered medical expenses before your insurance plan begins to pay. For example, if you have a $1,000 deductible and 20% coinsurance, you will generally pay 100% of expenses up to $1,000. After that, you’ll pay 20% until you reach your out-of-pocket maximum. The out-of-pocket maximum is the most you have to pay in one year, out-of-pocket, for your health care before your insurance plan covers 100% of the bill.

If your insurance plan is in the MDLIVE network, we will typically know your obligation concerning copays, coinsurance, and deductibles. We will use that information to inform you of your likely out-of-pocket costs for your MDLIVE visit.

Most doctor visit copays, including MDLIVE visits, typically do not count toward your annual deductible. The most common items that count toward deductibles are surgeries, lab tests, diagnostic tests, and hospitalization.

If your MDLIVE virtual visit is not covered by a copay, it may be eligible to count toward your deductible. Consult your insurance plan for details.

These accounts are ways to pay for qualified healthcare expenses with pre-tax dollars, but they differ in several ways. Individuals can contribute to a HSA if they are enrolled in a qualifying HDPD. The individual owns these accounts, and the money does not expire.

An FSA is an account that individuals can contribute to in order to pay for qualifying expenses with pre-tax dollars; however, there are limits to rolling over the funds from year to year. FSAs 0003should be primarily used for known and anticipated healthcare spending because of the ‘use it or lose it’ feature.

Yes, you can use HSA or FSA funds to pay for the out-of-pocket cost of an MDLIVE visit.

For more information, please sign in to your MDLIVE account or register to check your copay. After that, get the MDLIVE app – available on Apple and Android devices – so you’ll be ready to have a virtual doctor visit anytime, anywhere.

*Source: Policy Genius Study

Tags: insurance, virtual visits, urgent care, copay, telehealth

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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:
Plan ID:	H4461-036
Provider:	Humana
Year:	2021
Type:	Local HMO
Monthly Premium C+D:	$0
Part C Premium:	$0
MOOP:	$5,900
Part D (Drug) Premium:	$0
Part D Supplemental Premium	$0
Total Part D Premium:	$0
Drug Deductible:	$0
Tiers with No Deductible:	0
Gap Coverage:	No
Benchmark:	not below the regional benchmark
Type of Medicare Health:	Enhanced Alternative
Drug Benefit Type:	Enhanced
Similar Plan:	H4461-037

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

No

Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	55% coinsurance (Out-of-Network)
Extractions	0% coinsurance
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	55% coinsurance (Out-of-Network)
Restorative services	0% coinsurance