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Missouri MedicareAdvantage Plans

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Medicare Advantage Plans in Independence, Missouri

Below are Medicare Advantage plans available to residents of Independence, Missouri. 8 carriers offer 24 plans throughout the city of Independence. Residents may chose plans from carriers such as Humana Insurance Company, Humana Health Plan Inc. and COVENTRY HEALTH CARE. This data has been made available by the Centers for Medicare & Medicaid Services (CMS) and is for informational purposes only. Some data may be inaccurate or incomplete. Please note that plans can vary by city, county, and state and all plans listed may not be available in all areas. To speak to an advisor and find the Medicare Advantage plan in Independence that is right for you complete the form at the top of the page.

Medicare Advantage Health Plans in the city of Independence

Carrier Plan Title Plan Type
Humana Insurance Company HumanaChoice H1716-001 (PPO) (H1716-001) Local Preferred Provider Organization

    Premium and Other Important Information

    • Package: 1 - MyOption Enhanced Dental PPO:
    • $19 monthly premium in addition to your $63 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
    • $5 000 out-of-pocket limit for Medicare-covered services.
    • $6 700 out-of-pocket limit for Medicare-covered services.
    • $63 monthly plan premium in addition to your monthly Medicare Part B premium.
    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
    • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

    Doctor Office Visits

    • $10 copay for each primary care doctor visit for Medicare-covered benefits.
    • $35 copay for each in-area network urgent care Medicare-covered visit
    • $35 copay for each specialist visit for Medicare-covered benefits.
    • 30% of the cost for each primary care doctor visit
    • 30% of the cost for each specialist visit
    Humana Insurance Company HumanaChoice H1716-020 (PPO) (H1716-020) Local Preferred Provider Organization

      Premium and Other Important Information

      • Package: 1 - MyOption Dental High PPO:
      • Package: 2 - MyOption Dental Low PPO:
      • Package: 3 - MyOption Vision:
      • Package: 4 - MyOption Plus:
      • $21 monthly premium in addition to your $39 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
      • $14 monthly premium in addition to your $39 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
      • $15 monthly premium in addition to your $39 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
      • $25 monthly premium in addition to your $39 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Exams Eye Wear
      • $1 500 plan coverage limit every year for these benefits.
      • $1 000 plan coverage limit every year for these benefits.
      • $290 plan coverage limit every year for these benefits.
      • $5 000 out-of-pocket limit for Medicare-covered services.
      • $500 annual deductible. Contact the plan for services that apply.
      • $6 700 out-of-pocket limit for Medicare-covered services.
      • $39 monthly plan premium in addition to your monthly Medicare Part B premium.
      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
      • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

      Doctor Office Visits

      • $15 copay for each primary care doctor visit for Medicare-covered benefits.
      • $35 copay for each in-area network urgent care Medicare-covered visit
      • $35 copay for each specialist visit for Medicare-covered benefits.
      • 30% of the cost for each primary care doctor visit
      • 30% of the cost for each specialist visit
      Humana Health Plan Inc. Humana Gold Plus H2649-004 (HMO) (H2649-004) HMO

        Premium and Other Important Information

        • Package: 1 - MyOption Enhanced Dental HMO:
        • $21 monthly premium in addition to your $20 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
        • $3 400 out-of-pocket limit for Medicare-covered services.
        • $20 monthly plan premium in addition to your monthly Medicare Part B premium.
        • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

        Doctor Office Visits

        • Authorization rules may apply.
        • $10 copay for each primary care doctor visit for Medicare-covered benefits.
        • $35 copay for each in-area network urgent care Medicare-covered visit
        • $35 copay for each specialist visit for Medicare-covered benefits.
        Humana Health Plan Inc. Humana Gold Plus H2649-012 (HMO) (H2649-012) HMO

          Premium and Other Important Information

          • Package: 1 - MyOption Enhanced Dental HMO:
          • $21 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
          • $3 400 out-of-pocket limit for Medicare-covered services.
          • $0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
          • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i

          Doctor Office Visits

          • Authorization rules may apply.
          • $0 copay for each primary care doctor visit for Medicare-covered benefits.
          • $15 copay for each in-area network urgent care Medicare-covered visit
          • $15 copay for each specialist visit for Medicare-covered benefits.
          Humana Health Plan Inc. Humana Reader's Digest Healthy Living Plan (HMO) (H2649-024) HMO

            Premium and Other Important Information

            • $4 100 out-of-pocket limit for Medicare-covered services.
            • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
            • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

            Doctor Office Visits

            • Authorization rules may apply.
            • $15 copay for each primary care doctor visit for Medicare-covered benefits.
            • $40 copay for each in-area network urgent care Medicare-covered visit
            • $40 copay for each specialist visit for Medicare-covered benefits.
            COVENTRY HEALTH CARE Advantra Advantage (HMO) (H2672-001) HMO

              Premium and Other Important Information

              • $3 400 out-of-pocket limit. All plan services included.
              • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
              • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

              Doctor Office Visits

              • $5 copay for each primary care doctor visit for Medicare-covered benefits.
              • $30 copay for each in-area network urgent care Medicare-covered visit
              • $30 copay for each specialist visit for Medicare-covered benefits.
              WindsorSterling WindsorSterling Silver Connect Plan (PFFS) (H3410-002) Private Fee for Service

                Premium and Other Important Information

                • $4 000 out-of-pocket limit. All plan services included.
                • $30.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                • $25.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                • $49.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                • $35.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                • $29.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                • $40.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i
                • This plan does not allow providers to balance bill (charging more than your cost share amount).

                Doctor Office Visits

                • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                • $10 copay for each in-area network urgent care Medicare-covered visit
                • $30 copay for each specialist visit for Medicare-covered benefits.
                • $25 copay for each primary care doctor visit
                • $40 copay for each specialist visit
                WindsorSterling WindsorSterling Gold Connect Plan (PFFS) (H3410-003) Private Fee for Service

                  Premium and Other Important Information

                  • $4 000 out-of-pocket limit. All plan services included.
                  • $59 monthly plan premium in addition to your monthly Medicare Part B premium.
                  • $55 monthly plan premium in addition to your monthly Medicare Part B premium.
                  • $79 monthly plan premium in addition to your monthly Medicare Part B premium.
                  • $60 monthly plan premium in addition to your monthly Medicare Part B premium.
                  • $65 monthly plan premium in addition to your monthly Medicare Part B premium.
                  • $70 monthly plan premium in addition to your monthly Medicare Part B premium.
                  • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                  • This plan does not allow providers to balance bill (charging more than your cost share amount).

                  Doctor Office Visits

                  • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                  • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                  • $10 copay for each in-area network urgent care Medicare-covered visit
                  • $30 copay for each specialist visit for Medicare-covered benefits.
                  • $25 copay for each primary care doctor visit
                  • $40 copay for each specialist visit
                  WindsorSterling WindsorSterling Emerald Connect Plan (PFFS) (H3410-004) Private Fee for Service

                    Premium and Other Important Information

                    • $6 700 out-of-pocket limit. All plan services included.
                    • $28.5 monthly plan premium in addition to your monthly Medicare Part B premium.
                    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                    • This plan does not allow providers to balance bill (charging more than your cost share amount).

                    Doctor Office Visits

                    • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                    • $20 copay for each primary care doctor visit for Medicare-covered benefits.
                    • $20 copay for each in-area network urgent care Medicare-covered visit
                    • $35 copay for each specialist visit for Medicare-covered benefits.
                    • 20% of the cost for each primary care doctor visit
                    • 20% of the cost for each specialist visit
                    Universal Health Care Insurance Company Inc. Universal Hassle-Free (PPO) (H5096-001) Local Preferred Provider Organization

                      Premium and Other Important Information

                      • $6 700 out-of-pocket limit for Medicare-covered services.
                      • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                      • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                      Doctor Office Visits

                      • $15 copay for each primary care doctor visit for Medicare-covered benefits.
                      • $40 copay for each specialist visit for Medicare-covered benefits.
                      • $15 copay for each primary care doctor visit
                      • $40 copay for each specialist visit
                      Universal Health Care Insurance Company Inc. Universal Hassle-Free MA Only (PPO) (H5096-002) Local Preferred Provider Organization

                        Premium and Other Important Information

                        • Universal Health Care Insurance Company Inc. will reduce your monthly Medicare Part B premium by up to $ 10.00.
                        • $6 700 out-of-pocket limit for Medicare-covered services.
                        • $0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                        • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i
                        • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                        Doctor Office Visits

                        • $15 copay for each primary care doctor visit for Medicare-covered benefits.
                        • $40 copay for each specialist visit for Medicare-covered benefits.
                        • $15 copay for each primary care doctor visit
                        • $40 copay for each specialist visit
                        WindsorSterling WindsorSterling Gold Plus Plan (PPO) (H5162-006) Local Preferred Provider Organization

                          Premium and Other Important Information

                          • $4 000 out-of-pocket limit. All plan services included.
                          • $50 monthly plan premium in addition to your monthly Medicare Part B premium.
                          • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                          • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                          Doctor Office Visits

                          • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                          • $30 copay for each specialist visit for Medicare-covered benefits.
                          • $25 copay for each primary care doctor visit
                          • $40 copay for each specialist visit
                          Universal American Corp. Today's Options Advantage Plus 450F (PPO) (H5378-184) Local Preferred Provider Organization

                            Premium and Other Important Information

                            • $6 700 out-of-pocket limit for Medicare-covered services.
                            • $51 monthly plan premium in addition to your monthly Medicare Part B premium.
                            • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                            • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                            Doctor Office Visits

                            • $25 copay for each primary care doctor visit for Medicare-covered benefits.
                            • $35 copay for each in-area network urgent care Medicare-covered visit
                            • $50 copay for each specialist visit for Medicare-covered benefits.
                            • $30 copay for each primary care doctor visit
                            • $60 copay for each specialist visit
                            Universal American Corp. Today's Options Advantage Plus 250A (PPO) (H5378-200) Local Preferred Provider Organization

                              Premium and Other Important Information

                              • $3 250 out-of-pocket limit for Medicare-covered services.
                              • $122 monthly plan premium in addition to your monthly Medicare Part B premium.
                              • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                              • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                              Doctor Office Visits

                              • $5 copay for each primary care doctor visit for Medicare-covered benefits.
                              • $35 copay for each in-area network urgent care Medicare-covered visit
                              • $30 copay for each specialist visit for Medicare-covered benefits.
                              • $10 copay for each primary care doctor visit
                              • $40 copay for each specialist visit
                              COVENTRY HEALTH CARE Advantra Freedom (PPO) (H5509-001) Local Preferred Provider Organization

                                Premium and Other Important Information

                                • $3 950 out-of-pocket limit. All plan services included.
                                • $10 000 out-of-pocket limit. All plan services included.
                                • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                                • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                Doctor Office Visits

                                • $20 copay for each primary care doctor visit for Medicare-covered benefits.
                                • $20 copay for each in-area network urgent care Medicare-covered visit
                                • $40 copay for each specialist visit for Medicare-covered benefits.
                                • 30% of the cost for each primary care doctor visit
                                • 30% of the cost for each specialist visit
                                UnitedHealthcare AARP MedicareComplete Plus Plan 1 (HMO-POS) (H5749-001) HMO with POS Option

                                  Premium and Other Important Information

                                  • Package: 1 - Fitness Rider:
                                  • $13 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Supplemental Education/Wellness Programs
                                  • $3 400 out-of-pocket limit for Medicare-covered services.
                                  • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                                  • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                  Doctor Office Visits

                                  • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                                  • $30 copay for each in-area network urgent care Medicare-covered visit
                                  • $40 copay for each specialist visit for Medicare-covered benefits.
                                  Care Improvement Plus Care Improvement Plus Medicare Advantage (PPO) (H6528-005) Local Preferred Provider Organization

                                    Premium and Other Important Information

                                    • $6 700 out-of-pocket limit for Medicare-covered services.
                                    • $38 monthly plan premium in addition to your monthly Medicare Part B premium.
                                    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                    • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                    Doctor Office Visits

                                    • $35 copay for each primary care doctor visit for Medicare-covered benefits.
                                    • $35 copay for each in-area network urgent care Medicare-covered visit
                                    • $50 copay for each specialist visit for Medicare-covered benefits.
                                    • $35 copay for each primary care doctor visit
                                    • $50 copay for each specialist visit
                                    Care Improvement Plus Care Improvement Plus Silver Rx (PPO SNP) (H6528-012) Local Preferred Provider Organization

                                      Premium and Other Important Information

                                      • $6 700 out-of-pocket limit for Medicare-covered services.
                                      • In 2012 the annual Part B deductible amount is $140. Contact the plan for services that apply.
                                      • $32.1 monthly plan premium in addition to your monthly Medicare Part B premium.
                                      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                      • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                      Doctor Office Visits

                                      • 20% of the cost for each primary care doctor visit for Medicare-covered benefits.
                                      • 20% of the cost for each in-area network urgent care Medicare-covered visit
                                      • 20% of the cost for each specialist visit for Medicare-covered benefits.
                                      • 20% of the cost for each primary care doctor visit
                                      • 20% of the cost for each specialist visit
                                      Care Improvement Plus Care Improvement Plus Gold Rx (PPO SNP) (H6528-013) Local Preferred Provider Organization

                                        Premium and Other Important Information

                                        • $6 700 out-of-pocket limit for Medicare-covered services.
                                        • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                                        • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                        • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                        Doctor Office Visits

                                        • $35 copay for each primary care doctor visit for Medicare-covered benefits.
                                        • $35 copay for each in-area network urgent care Medicare-covered visit
                                        • $50 copay for each specialist visit for Medicare-covered benefits.
                                        • $35 copay for each primary care doctor visit
                                        • $50 copay for each specialist visit
                                        Care Improvement Plus Care Improvement Plus Dual Advantage (PPO SNP) (H6528-014) Local Preferred Provider Organization

                                          Premium and Other Important Information

                                          • * Depending on your level of Medicaid eligibility you may not have any cost-sharing responsibility for original Medicare services
                                          • $0 annual deductible.*
                                          • ** Please consult with your plan about cost sharing when receiving services from out-of-network providers.
                                          • $6 700 out-of-pocket limit for Medicare-covered services. However in this plan you will have no cost sharing responsibility for Medicare-covered services based on your level of Medicaid eligibility.
                                          • $0 annual deductible.**
                                          • $6 700 out-of-pocket limit for Medicare-covered services. However in this plan you will have no cost sharing responsibility for Medicare-covered services based on your level of Medicaid eligibility.**
                                          • $0 monthly plan premium*
                                          • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                          Doctor Office Visits

                                          • $0 copay for each primary care doctor visit for Medicare-covered benefits.*
                                          • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.*
                                          • $0 copay for each specialist doctor visit for Medicare-covered benefits.*
                                          • 20% of the cost for each primary care doctor visit**
                                          • 20% of the cost for each specialist visit**
                                          Universal Health Care Insurance Company Inc. Any Any Any Gold (PFFS) (H8098-001) Private Fee for Service

                                            Premium and Other Important Information

                                            • $6 700 out-of-pocket limit for Medicare-covered services.
                                            • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                                            • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                            • This plan does not allow providers to balance bill (charging more than your cost share amount).

                                            Doctor Office Visits

                                            • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                                            • $15 copay for each primary care doctor visit for Medicare-covered benefits.
                                            • $40 copay for each specialist visit for Medicare-covered benefits.
                                            • $15 copay for each primary care doctor visit
                                            • $40 copay for each specialist visit
                                            Universal Health Care Insurance Company Inc. Any Any Any Gold MA Only (PFFS) (H8098-003) Private Fee for Service

                                              Premium and Other Important Information

                                              • Universal Health Care Insurance Company Inc. will reduce your monthly Medicare Part B premium by up to $ 15.00.
                                              • $6 700 out-of-pocket limit for Medicare-covered services.
                                              • $0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                                              • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i
                                              • This plan does not allow providers to balance bill (charging more than your cost share amount).

                                              Doctor Office Visits

                                              • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                                              • $15 copay for each primary care doctor visit for Medicare-covered benefits.
                                              • $40 copay for each specialist visit for Medicare-covered benefits.
                                              • $15 copay for each primary care doctor visit
                                              • $40 copay for each specialist visit
                                              Humana Insurance Company Humana Gold Choice H8145-120 (PFFS) (H8145-120) Private Fee for Service

                                                Premium and Other Important Information

                                                • Package: 1 - MyOption Fitness Well Being:
                                                • $30 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Supplemental Education/Wellness Programs
                                                • $162 annual deductible. Contact the plan for services that apply.
                                                • $6 700 out-of-pocket limit for Medicare-covered services.
                                                • $0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                                                • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i
                                                • This plan does not allow providers to balance bill (charging more than your cost share amount).

                                                Doctor Office Visits

                                                • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                                                • 20% of the cost for each primary care doctor visit for Medicare-covered benefits.
                                                • 20% of the cost for each in-area network urgent care Medicare-covered visit
                                                • 20% of the cost for each specialist visit for Medicare-covered benefits.
                                                • 20% of the cost for each primary care doctor visit
                                                • 20% of the cost for each specialist visit
                                                Humana Insurance Company Humana Gold Choice H8145-125 (PFFS) (H8145-125) Private Fee for Service

                                                  Premium and Other Important Information

                                                  • Package: 1 - MyOption Dental High PPO:
                                                  • Package: 2 - MyOption Dental Low PPO:
                                                  • Package: 3 - MyOption Vision:
                                                  • Package: 4 - MyOption Plus:
                                                  • $20 monthly premium in addition to your $33 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                                  • $13 monthly premium in addition to your $33 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                                  • $15 monthly premium in addition to your $33 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
                                                  • $24 monthly premium in addition to your $33 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Exams Eye Wear
                                                  • $1 500 plan coverage limit every year for these benefits.
                                                  • $1 000 plan coverage limit every year for these benefits.
                                                  • $290 plan coverage limit every year for these benefits.
                                                  • $5 000 out-of-pocket limit for Medicare-covered services.
                                                  • $33 monthly plan premium in addition to your monthly Medicare Part B premium.
                                                  • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                                  • This plan does not allow providers to balance bill (charging more than your cost share amount).

                                                  Doctor Office Visits

                                                  • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                                                  • $15 copay for each primary care doctor visit for Medicare-covered benefits.
                                                  • $35 copay for each in-area network urgent care Medicare-covered visit
                                                  • $35 copay for each specialist visit for Medicare-covered benefits.
                                                  • $15 copay for each primary care doctor visit
                                                  • $35 copay for each specialist visit

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