Plan Details

Humana Gold Plus Integrated: Live a healthier, fuller life

Humana Gold Plus Integrated, A Commonwealth Coordinated Care Plan (Medicare-Medicaid Plan) helps you take control of your health and get the most out of your coverage. You’ll have all the features of original Medicare, plus extra benefits like rides to medical appointments, and added vision, hearing, and dental coverage.

"In Network" and "Out of Network" -- What's the difference?

In network providers are doctors, nurses, and other health care professionals that you can go to as a member of our plan. Network providers also include clinics, hospitals, nursing facilities, and other places that provide health services in our plan. They also include home health agencies, medical equipment suppliers, non-emergent transportation and others who provide goods and services that you get through Medicare or Medicaid.

Network providers have agreed to accept payment from our plan for covered services as payment in full.

Out of network providers are health care professionals that will not accept Humana Gold Plus Integrated as payment for services.

Do I have to use network providers to get care?

You must get your care from network providers. Usually, the plan will not cover care from a provider who does not work with the health plan. Here are some cases when this rule does not apply:

  • The plan covers emergency or urgently needed care from an out-of-network provider.
  • If you need care that our plan covers and our network providers cannot give it to you, you can get the care from an out-of-network provider. Your PCP will arrange for this out-of-network care. You must obtain authorization from the plan prior to seeking care from an out-of-network provider. In this situation, we will cover the care as if you got it from a network provider.
  • The plan covers kidney dialysis services when you are outside the plan’s service area for a short time. You can get these services at a Medicare-certified dialysis facility.
  • When you first join the plan, you can continue seeing any out-of-network providers you see now for up to 180 days.
  • If you are joining the plan from another Medicare-Medicaid Plan you can continue seeing your current provider for up to 30 days.
  • If you are currently pregnant, you may choose to remain with your current doctor of obstetrical and gynecological services until six (6) weeks after the delivery of your baby.

What are Network Pharmacies?

Network pharmacies are pharmacies (drug stores) that have agreed to fill prescriptions for our plan members. Use the Provider and Pharmacy Directory to find the network pharmacy you want to use.

Except during an emergency, you must fill your prescriptions at one of our network pharmacies if you want our plan to help you pay for them.

What are the limits on seeing a doctor out of the Humana Gold Plus Integrated Network?

If your provider is part of your new health plan’s network, you many continue to see him/her. Humana Gold Plus Integrated will allow you to continue seeing your current doctors and other providers up to 180 days from the time you enroll in the plan. If you are joining the plan from another Medicare-Medicaid Plan you can continue seeing your current provider for up to 30 days. After that, you will have to see providers that are part in the Humana Gold Plus Integrated network. Urgent or emergency care is covered under Commonwealth Coordinated Care. For further information on co-pays and limitations, please see the Humana Gold Plus Integrated Benefits at a Glance.