As the calendar inches closer to 2026, many of us are starting to think about our healthcare coverage. It's a natural part of planning, and for those in Brooklyn and Queens, New York City, the Humana Gold Plus H3533-033 (HMO) plan is likely on your radar. Let's break down what this Medicare Advantage HMO plan, which has a contract with Medicare, might offer you.
First off, it's crucial to remember that while this summary gives you a good overview, it's not the whole story. The full details, including every covered service, limitation, and exclusion, are laid out in the Evidence of Coverage (EOC). You can find this on Humana.com/PlanDocuments or by giving them a call. It's always a good idea to peek at this before you commit, just to make sure everything aligns with your needs.
Eligibility and Key Considerations
To be eligible for the Humana Gold Plus H3533-033 (HMO) plan, you'll need to be eligible for Medicare Part A, enrolled in Medicare Part B, and reside within their service area, which includes Kings and Queens counties in New York. A vital point to note is that you must continue paying your Medicare Part B premium, though this plan aims to reduce it by up to $1 monthly, not exceeding your 2025 Part B premium cost.
Understanding Your Costs
When it comes to monthly costs, the plan itself has a $0 premium. However, you'll still be responsible for your Medicare Part B premium. The plan outlines a medical deductible of $580 for in-network services, with certain services like ambulance, chemotherapy drugs, emergency room visits, and lab services excluded from this deductible. For prescription drugs, there's a tiered deductible: $0 for Tier 1 and 2, and $590 for Tiers 3, 4, and 5. The out-of-pocket maximum for in-network medical services is set at $9,350 for the year.
What's Covered: A Snapshot
The plan offers comprehensive benefits. For inpatient hospital stays, there's no limit on the number of days, with a $310 copay for the first 1-6 days and $0 for days 7-90. Outpatient hospital services have varying copays, for example, $495 for a colonoscopy and $90 for a mammogram. Doctor visits are covered with a $0 copay for Primary Care Providers (PCPs), whether in-office or via telehealth, and $45 for specialists. Importantly, you don't need a referral to see a plan provider, but some services and medications might require prior authorization.
Preventive care is a strong focus, covering all Medicare-approved preventive services like annual wellness visits, cancer screenings, immunizations, and diabetes screenings, all with a $0 copay. Emergency and urgent care services are also covered, with a $110 copay for emergency room services and $0 for the doctor and professional services within the ER. Urgent care centers and telehealth for urgent needs also have a $45 copay.
Diagnostic services, lab work, and imaging are detailed with specific copays depending on the service and location (e.g., independent imaging facility vs. hospital outpatient). For instance, advanced imaging like MRIs and CT scans range from $200 to $325 depending on the setting.
Beyond Medical: Hearing and Dental
Humana Gold Plus H3533-033 (HMO) also includes hearing and dental benefits. Medicare-covered hearing services have a $45 copay. Additionally, there's a mandatory hearing supplemental benefit (HER937) that offers one routine hearing exam annually at no cost, and discounts on hearing aids, with copays of $699 for premium models and $999 for superior models. These hearing aid purchases include TruHearing provider visits, a 60-day trial, a 3-year warranty, and battery supply. For dental, Medicare-covered dental items have a $45 copay, and there are mandatory supplemental dental benefits, though these have limitations and exclusions and are subject to review.
Important Reminders
It's worth noting that benefits, premiums, and/or copays/coinsurance may change for 2026. If you have other coverage like TRICARE or a Medicare Supplement plan, your coverage might be affected, so it's wise to check with those providers. Also, remember that out-of-network providers are generally not covered unless it's an emergency or urgent care situation.
If you're dual-eligible, meaning you have both Medicare and Medicaid, you might have even lower costs. Be sure to present both your Medicaid ID and Humana card to providers.
Choosing a health plan is a personal journey, and understanding the specifics is key. For any questions, Humana's customer service is available at 1-800-833-2364 (TTY: 711). Members can reach out at 1-800-457-4708 (TTY: 711).
