New to Humana

You may have received a letter that your Medicare and Medicaid services are now with Humana. Welcome to Humana Gold Plus Integrated, A Commonwealth Coordinated Care Plan (Medicare-Medicaid Plan)! Your plan has switched to Humana for one of two reasons:

  • 1) You selected Humana
  • 2) You didn't select a plan and the Commonwealth of Virginia picked one for you. This is called Passive Enrollment. 

It is important to know that you keep all the benefits and services you received with the plan you had before, plus you get extra benefits including:

  • Vision, hearing and dental coverage
  • Smoking Cessation
  • Meal Delivery (WellDine)
  • 24 Hour Nursing Hotline
  • Health Education

We are glad to have you on Humana Gold Plus Integrated and want to answer any questions you may have. If you have questions, please call Humana Gold Plus Integrated at 1-855-280-4002, TTY: 711, 8 a.m. – 8 p.m., Monday – Friday. The call is free.

What to expect when you first join a health plan

Members newly enrolled in the Commonwealth Coordinated Care Plan are offered a 180-day transition period in which you may maintain a current course of treatment with a provider who is currently out of the Humana Gold Plus Integrated network. If you are transferring to our plan from an existing Commonwealth Coordinated Care Plan you will be offered a 30-day transition period in which you may maintain a current course of treatment with a provider who is currently out of the Humana Gold Plus Integrated network.  If you are in a nursing facility when your enrollment in Humana Gold Plus Integrated begins, you may remain in the facility as long as you continue to meet the criteria for nursing facility care, unless you or your family prefers to move to a different nursing facility or return to the community. Nursing facility continued stay criteria is established by the Virginia Department of Medical Assistance Services.

After 180 days in our plan, you will need to see doctors and other providers in the Humana Gold Plus Integrated network. A network provider is a provider who works with the health plan. See your Member Handbook for more information on getting care.

When you first become a member with Humana Gold Plus Integrated, you may need help with your medications as you move to our plan. We want to make this as easy as possible. You will have access to at least one 30-day supply of the Part D drugs you currently take during your first 90 days in the plan and you will have access to the Medicaid-covered drugs you currently take during your first 180 days in the plan (1) if you are taking a drug that is not on our List of Covered Drugs, (2) if health plan rules do not let you get the amount ordered by your doctor, or (3) if the drug requires prior approval by Humana Gold Plus Integrated.

If you live in a Long Term Care Facility we will cover a supply of your drug during the first 90 days of your membership in the plan, until we have given you a 93 day supply consistent with the dispensing increment, or less if your prescription is written for fewer days.

Please call us at 1-855-280-4002 (TTY: 711) if you have any questions.

We have free interpreter services to answer any questions you may have about our health and drug plans. If you'd like to use an interpreter, call us at 1-855-280-4002 (TTY: 711).

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Humana takes a personalized approach with care that’s more accessible and patient-centered. Humana does this through the completion of a Health Risk Assessment (HRA). The HRA helps us understand your healthcare needs. For our members in long term care, skilled nursing facility, or on an EDCD waiver, we complete the assessment during a face-to-face visit. For other members, we will attempt to reach you by phone to complete the assessment. If we can’t reach you by phone, then we will mail you the assessment form and/or visit you in your home to complete it should you wish, or you can mail it back to us.

We will send you a pre-addressed, postage paid return envelope to send it back. If you need help completing the form, we can call you or meet face-to-face. If you need help, call Customer Care at 1-855-280-4002 (TTY:711). We’re available Monday – Friday, from 8 a.m. – 8 p.m. Eastern Time. However, please note that our automated phone system may answer your call after hours, during weekends, and holidays. Please leave your name and telephone number, and we’ll call you back by the end of the next business day.