Humana Gold Plus HMO D SNP

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

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

Key Takeaways

• The Humana Gold Plus HMO D-SNP is a Medicare Advantage plan that has been designed for individuals who qualify for both Medicare and Medicaid, offering coordinated care and sometimes prescription drug coverage.

• 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 could have access to extensive health care services such as language assistance and a clear grievance and appeals process available.

The Humana Gold Plus HMO D-SNP is a Medicare Advantage HMO plan that could be tailored for individuals who qualify for both Medicare and Medicaid.

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.

Some of the primary recipients of this plan may include:

• FBDE

• QDWI

• QI

• QMB

• QMB+

• SLMB

• SLMB+

The plan will likely be available in various states like New York, Ohio, or Pennsylvania. This plan may also encompass specialized benefits like prescription drug coverage and free language interpreter services for non-English speaking members, possibly ensuring that you could 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 certain Medicaid benefits.

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.

Moreover, D-SNP might not just be 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 disabilities may be eligible for D-SNP if they meet the criteria of being dual eligible for both Medicare and Medicaid.

Enrollment Periods and Procedures

The D-SNP enrollment process will likely entail eligibility verification, application completion, and confirmation.

The enrollment process may vary slightly for newcomers compared to existing beneficiaries. For newcomers, this may involve calling one of our licensed agents at 1-833-641-4938 (TTY 711), Mon-Fri 8 am-9 pm EST. On the other hand, existing beneficiaries may need to select a plan and submit an application directly to the plan.

To complete the enrollment process, it will likely be necessary to submit the application electronically through the Health Plan Management System (HPMS) to CMS. In some states, D-SNPs may be required to have executed contracts with the Department of Health Care Services (DHCS), the state Medicaid agency.

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.

Tailored Health Coverage

The Humana Gold Plus HMO D-SNP plan might offer:

• 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,

• Coordinated care through a Medicare contract and a contract with the state Medicaid program

This approach could emphasize the coordination of various care services to deliver comprehensive healthcare.

The network of providers in Humana Gold Plus HMO D-SNP will likely be significant as this could ensure that members may have access to a wide range of healthcare services and support, which may be outlined in the plan’s guides for better health and medication management.

Coordinated Care Approach

To improve health outcomes and potentially reduce expenses, the coordinated care approach could deliver high-quality, personalized healthcare.

It may also align services with patients’ needs and preferences, possibly ensuring that high-quality care can be delivered efficiently and effectively.

Through the use of their Medicare contract and a network of healthcare providers, Humana Gold Plus HMO D-SNP will likely ensure an appropriate level of care for its members.

This approach could not only prevent unnecessary admissions, emergency department visits, and duplicate tests and procedures, but it could also ensure that care may be appropriate and timely.

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 will likely include a wide range of health care providers including dentists and optometrists.

To change providers within the network, members could 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.

Potential Prescription Drug Benefits

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

Specialty pharmacies may have a crucial function within the Humana Gold Plus HMO D-SNP as they will likely oversee treatments for chronic and complex illnesses and offer a comprehensive health approach, which could form an essential component of the members’ prescription drug benefits.

To obtain their prescription drugs, members may log into MyHumana, search for drugs to confirm coverage by their plan, and price their prescriptions, as part of the convenience that might be offered by the potential prescription drug benefits.

Medication Therapy Management

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

To be eligible for the medication therapy management program, individuals must satisfy specific eligibility criteria. This mandatory program may be integrated into the potential benefit structure of Humana Gold Plus HMO D-SNP and all Part D Sponsors, possibly making it a significant value proposition.

Specialty Pharmacy Access

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

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

Some of the medications that might be offered by specialty pharmacies may include Zolgensma, utilized for the treatment of spinal muscular dystrophy, and Harvoni, a cure for Hepatitis C.

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