Humana Gold Plus HMO D SNP

Understanding the benefits of the Humana Gold Plus HMO D-SNP plan is crucial if you’re dual-eligible for Medicare and Medicaid.

This article provides a straightforward overview of the core Humana Gold Plus HMO D-SNP benefits, enrollment guidelines, and cost-saving features the plan offers its members. Discover how to fully utilize your healthcare coverage, the prescription drug benefits included, and the additional perks that set this plan apart from others.

Key Takeaways

• The Humana Gold Plus HMO D-SNP is a Medicare Advantage plan designed for individuals who qualify for both Medicare and Medicaid, offering coordinated care, prescription drug coverage, and additional benefits such as a Healthy Options Allowance.

• Eligibility for the Humana Gold Plus HMO D-SNP plan requires enrolment in Medicare Part A and B, Medicaid benefits, and adherence to criteria set for income and assets; the plan is non-discriminatory and provides special enrollment periods.

• Members of the Humana Gold Plus HMO D-SNP have access to extensive health care services including wellness programs, transportation services for medical appointments, and a medication therapy management program, with language assistance and a clear grievance and appeals process available.

The Humana Gold Plus HMO D-SNP is a Medicare Advantage HMO plan tailored for individuals who qualify for both Medicare and Medicaid. Intricately woven, the plan’s fabric includes a Healthy Options Allowance that helps cover expenses like food, pet supplies, utility bills, or rent, as well as access to lower-cost preferred pharmacies.

With the variety of options available, it’s essential to understand the differences between Medicare Advantage HMO PPO plans to make the best choice for your healthcare needs.

The primary recipients of this plan include:

• FBDE
• QDWI
• QI
• QMB
• QMB+
• SLMB
• SLMB+

The plan is available in states like ny oh or pa. It encompasses specialized benefits like prescription drug coverage and free language interpreter services for non-English speaking members, ensuring that you get the care you need, when you need it.

Eligibility Criteria for D-SNP

Eligibility for a D-SNP plan like Humana Gold Plus HMO D-SNP requires individuals to be enrolled in both Medicare Part A and Part B, in addition to receiving Medicaid benefits. This is true for states like CA, CT, DC, and DE where the plan is available.

As long as you’re 21 years of age or older, and you meet the income and asset criteria set for Medicaid, you are eligible for D-SNP, regardless of your race, color, or national origin.

Moreover, D-SNP is not just for U.S. citizens. If you’re a lawful permanent resident, you can qualify, regardless of your race, color, national origin, age, disability, or sex. Even individuals with national origin age disability can be eligible for D-SNP if they meet the criteria of being dual eligible for both Medicare and Medicaid, regardless of their disability, sex, or sexual orientation.

Enrollment Periods and Procedures

The D-SNP enrollment process entails eligibility verification, application completion and confirmation, along with any additional required steps, adhering to non-discrimination principles based on origin, age, disability, sex, sexual orientation, gender, or sexual orientation gender identity, including disability sex sexual orientation.

The enrollment process varies slightly for newcomers compared to existing beneficiaries. For newcomers, it entails signing up online, contacting Social Security, or completing an online application. On the other hand, existing beneficiaries may need to select a plan, submit an application directly to the plan, or initiate a telephonic enrollment, without discrimination based on sex, sexual orientation, or gender.

To complete the enrollment process, it is necessary to submit the application electronically through the Health Plan Management System (HPMS) to CMS. In California (ca ct dc de), D-SNPs are required to have executed contracts with the Department of Health Care Services (DHCS), the state Medicaid agency, without discrimination based on color, national origin, or age.

Additionally, the agency ensures compliance with regulations across multiple states, including md me mi mn.

Furthermore, there are designated special enrollment periods for the Humana Gold Plus HMO D-SNP plan. These periods afford the opportunity to enroll in or change a Medicare Advantage plan outside of the Initial Coverage Election Period (ICEP) or the annual Medicare Open Enrollment Period, without discrimination based on national origin, age, or disability.

Tailored Health Coverage

The Humana Gold Plus HMO D-SNP plan offers:

• A tailored solution instead of a one-size-fits-all approach
• Personalized, integrated care that caters to the distinct health requirements of individuals enrolled in both Medicare and Medicaid, without discrimination based on age, disability, sex, or sexual orientation
• Coordinated care through a Medicare contract and a contract with the state Medicaid program

This approach emphasizes the coordination of various care services to deliver comprehensive healthcare, without discrimination based on identity or expression transgender status marital.

The network of providers in Humana Gold Plus HMO D-SNP is significant as it ensures that members have access to a wide range of healthcare services and support, all of which are outlined in the plan’s guides for better health and medication management, without discrimination based on identity or expression, including transgender individuals.

Coordinated Care Approach

With an aim to improve health outcomes and reduce expenses, the coordinated care approach delivers high-quality, personalized healthcare, treating all patients equally, regardless of their military or veteran status.

It aligns services with patients’ needs and preferences, ensuring that high-quality care is delivered in an efficient and effective manner, without discrimination based on status, military, or veteran status.

Through the use of their Medicare contract and a network of healthcare providers, Humana Gold Plus HMO D-SNP ensures an appropriate level of care for its members, irrespective of their veteran status or religion. This approach not only prevents unnecessary admissions, emergency department visits, and duplicate tests and procedures, but also ensures that care is appropriate and timely, without discrimination based on gender identity or expression.

Network of Providers

Healthcare providers within the Humana Gold Plus HMO D-SNP network can be located by utilizing the online searchable directory available on the Humana website. This directory allows users to search for providers by:

• Name
• Condition
• Specialty
• Other relevant criteria

The network includes a wide range of health care providers including dentists and optometrists.

To change providers within the network, members can make use of Humana’s online search tools or consult the printed directories. Alternatively, you may also seek assistance from a Member Services specialist to locate a new in-network provider, including mental health therapists.

Prescription Drug Benefits

Humana Gold Plus HMO D-SNP provides prescription drug coverage as a component of its Medicare Advantage plan, encompassing a range of medications specified in the Humana Drug List, also referred to as the formulary.

The medication therapy management program offered by Humana Gold Plus HMO D-SNP provides a thorough assessment of medications to enhance therapeutic results, delivering guidance to patients on optimizing their medication regimen, particularly for individuals using multiple medicines.

Specialty pharmacies have a crucial function within the Humana Gold Plus HMO D-SNP as they oversee treatments for chronic and complex illnesses and offer a comprehensive health approach, which forms an essential component of the members’ prescription drug benefits. And, to obtain their prescription drugs, members can log into MyHumana, search for drugs to confirm coverage by their plan and price their prescriptions, as part of the convenience offered by the prescription drug benefits.

Medication Therapy Management

Designed to optimize medication use and enhance health outcomes, the medication therapy management program plays a pivotal role. This is achieved by ensuring optimal therapeutic results, minimizing the risk of adverse events, and reducing overall healthcare expenses.

To be eligible for the medication therapy management program, individuals must satisfy specific eligibility criteria and are projected to have annual Part D medication expenses of $4,696 in 2022. This mandatory program is integrated into the benefit structure of Humana Gold Plus HMO D-SNP and all Part D Sponsors, making it a significant value proposition.

Specialty Pharmacy Access

A specialty pharmacy is dedicated to providing high-cost, high-touch medication therapy for patients with complex disease states. It operates as a state-licensed pharmacy that primarily or exclusively dispenses medications for individuals with significant health conditions.

By providing access to intricate and high-cost medications that are crucial for the management of severe health conditions, specialty pharmacies offer substantial benefits to Humana Gold Plus HMO D-SNP members.

Examples of such intricate and high-value medications offered by specialty pharmacies include Zolgensma, which is utilized for the treatment of spinal muscular dystrophy, and Harvoni, which is a cure for Hepatitis C.

These specialty pharmacies also offer services including the delivery of medications to a preferred location, support in identifying financial assistance programs, and condition-specific services to provide additional support.