4

4 out of 5 stars* for plan year 2024

Plan ID: H5619-077

What You Need to Know:

  • Humana Gold Plus H5619-077 (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $26, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $150 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $5,000 per year (in-network).
  • Humana Gold Plus H5619-077 (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $150 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $23.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$26

Monthly Premium

Medicare Plan Features
Monthly Premium: $26.00
Part C Premium: $3.00
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$26.00 $3.00 $23.00 $0 $23.00 $150.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H5619-078
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $5,000
Annual Deductible: $150 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Canyon, Idaho: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
442 members 4 out of 5 Stars. 4 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,457 drugs
Number of Members Enrolled in this Plan in Canyon, Idaho: NULL
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$3.00 $23.00 $0.00 $26.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$3.00 $17.20 $20.20 $11.50 $14.50 $5.70 $8.70
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
306 $4.00 599 $15.00 783 $47.00 1085 $100.00 684 30%

Other Medicare Advantage Plans in Canyon, Idaho

Plan Name Type Premium MOOP Rx Deduct. Rating
True Blue Rx Gem (HMO) (2023)Local HMO$5,800$190
3
True Blue Rx Essentials (HMO) (2023)Local HMO$5,900$300
3
True Blue no Rx (HMO) (2023)Local HMO *$3,000$-
3
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$5,400$-
5
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) (2023)Local HMO$5,500$100
3
PacificSource Medicare Explorer 6 (PPO) (2023)Local PPO *$3,500$-
4
PacificSource Medicare MyCare Rx 32 (HMO) (2023)Local HMO$5,500$0
3
Regence MedAdvantage + Rx Primary (PPO) (2023)Local PPO$5,500$200
5
Regence MedAdvantage + Rx Classic (PPO) (2023)Local PPO$5,500$200
5
Humana Honor (PPO) (2023)Local PPO *$5,000$-
4
Regence Blue MedAdvantage HMO (HMO) (2023)Local HMO$5,500$200
5
Regence Blue MedAdvantage HMO Plus (HMO) (2023)Local HMO$5,200$110
5
MediGold Medical Only (HMO) (2023)Local HMO *$3,900$-
New plan - not yet rated.
UnitedHealthcare Medicare Advantage Assure (PPO) (2023)Local PPO$7,550$445
5
SelectHealth Advantage Essential (HMO) (2023)Local HMO$6,700$150
2
SelectHealth Advantage Enhanced (HMO) (2023)Local HMO$5,900$0
2
MediGold Essential Care (HMO) (2023)Local HMO$5,500$0
New plan - not yet rated.
MediGold True Advantage (HMO) (2023)Local HMO$4,500$0
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AARP Medicare Advantage Choice Plan 1 (PPO) (2023)Local PPO$4,700$190
5
AARP Medicare Advantage Choice Plan 2 (PPO) (2023)Local PPO$3,900$175
5
AARP Medicare Advantage (HMO) (2023)Local HMO$4,900$200
5
MediGold Classic Preferred (HMO) (2023)Local HMO$3,900$0
New plan - not yet rated.
True Blue Rx Option I (HMO) (2023)Local HMO$6,500$0
3
AARP Medicare Advantage Focus (HMO) (2023)Local HMO$4,900$100
5
Molina Medicare Choice Care (HMO) (2023)Local HMO$5,000$100
5
Aetna Medicare Elite Plan (HMO) (2023)Local HMO$6,900$0
New plan - not yet rated.
Aetna Medicare Value Plan (HMO) (2023)Local HMO$7,550$0
New plan - not yet rated.
True Blue Rx Option II (HMO) (2023)Local HMO$6,400$250
3
AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$6,700$200
5
Humana Community (HMO) (2023)Local HMO$5,500$100
5
HumanaChoice H5216-044 (PPO) (2023)Local PPO$6,000$200
4
True Blue Rx (HMO) (2023)Local HMO$6,200$125
3
HumanaChoice H5216-132 (PPO) (2023)Local PPO$5,500$200
4
Aetna Medicare Select Plan (PPO) (2023)Local PPO$7,000$0
5
Aetna Medicare Choice Plan (PPO) (2023)Local PPO$7,550$0
5
Regence Valiance (PPO) (2023)Local PPO *$5,900$-
5
True Blue Rx Preferred (HMO) (2023)Local HMO$5,900$185
3
Medicare Advantage Plans by Humana
Humana Honor (PPO) (2023)Local PPO *$5,000$-
4
Humana Community (HMO) (2023)Local HMO$5,500$100
5
HumanaChoice H5216-044 (PPO) (2023)Local PPO$6,000$200
4
HumanaChoice H5216-132 (PPO) (2023)Local PPO$5,500$200
4

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