Advantages & Disadvantages of the Humana Gold Plan

Humana Gold Plus and Humana Gold Choice are Medicare Advantage insurance plans which are offered as an alternative to the original Medicare plan available through the government. Medicare Advantage plans generally provide a significant savings over original Medicare.

Humana Gold Plus is a PPO provider, which limits your choice of doctors and hospitals to those in its network and requires a referral from your primary physician to visit a hospital or specialist. Original Medicare allows you to choose your own doctor and referrals are not required. Humana Gold Choice offers this benefit as well; however, doctors can choose on a case-by-case basis what services they will cover and are not required to provide treatment under the plan.

The Humana Gold Plus plan carries no additional monthly premium--the cost is covered by the original Medicare Part B premium, which in 2010 was $96.40 for most plan members. The Humana Gold Choice plan requires a premium of $35 in addition to the Medicare Part B premium.

Medicare and the Humana Gold Choice plan require 20 percent out-of-pocket payment for a routine office visit as well as any visits to specialists, ambulatory surgical centers, outpatient hospital facilities and ambulance services. Humana Gold Plus requires an established co-pay for each service. The 2010 co-pay for routine office visits is $5. Additional co-pays are $35 for a specialist or urgent care facility, $75 for ambulatory surgical centers, $50 to $150 for outpatient hospital facilities and $100 for ambulance services.

The Humana Gold Plus plan requires a $150 co-pay for the first 15 days. After 15 days, there is no co-pay, and there is no limit to the amount of days covered by the plan. The Humana Gold Choice and original Medicare require an $1,100 deductible for the first 60 days of a hospital stay. From Day 61 through Day 90, you are required to pay $275 per day. Beginning on Day 91, a 60-day lifetime reserve coverage kicks in and requires a co-payment of $550 per day. Under the original Medicare program, there is no coverage after Day 151; however, the Humana Gold Choice plan provides coverage from Day 151 and beyond with zero co-pay and does not limit the amount of days covered.

Prescription medications are covered under Medicare Part D, a separate insurance offered by the government. This insurance is subject to a co-pay and is limited to a set amount each calendar year. Once you reach this limit, benefits cease and payment for all medications is out-of-pocket until you reach the out-of-pocket maximum for the year. At this point "catastrophic coverage" begins. The period between these two limits is commonly called the "doughnut hole" and accounts for the biggest expense for most Medicare recipients. Medicare Advantage plans provide prescription drug benefits under their individual plans. The advantage of a Humana Gold plan is these plans provide some coverage when you have reached the maximum drug benefit available per year until you reach the catastrophic coverage stage.

MediGap, also called Medicare Supplement Insurance, is a separate policy you can purchase to help pay deductibles, co-pays and co-insurance. If you belong to Humana Gold Plus or Humana Gold Choice, you are not eligible to purchase MediGap insurance.