Costs
Humana Mri Copay Policy
Find your TRICARE costs, including copayments,enrollment fees, and payment options.
- Most costs are for calendar year 2021 unless noted separately.
- For US Family Health Plan and TRICARE Prime Remote costs, choose 'TRICARE Prime' from the pull-down menu
- Visit the Cost Terms page for definitions to help you better understand TRICARE costs.
- If you're an unremarried former spouse, for the Continued Health Care Benefit Program (CHCBP), chose 'Retired' regardless of your sponsor's status
- Looking for dental costs? Visit the TRICARE Dental Costs section.
- Humana National POS 10 Copay. Humana National POS 10 Copay plans 100/70 copay plan 90/60 copay plan 80/50 copay plan Plan pays for services from PARTICIPATING providers. MRI, MRA, CAT, SPECT). hospice. home health care (limited to 100 visits per calendar year).
- Diagnostic radiology $180 to $275 copay $180 to $275 copay Lab services $0 to $50 copay $0 to $50 copay Diagnostic tests and procedures $0 to $100 copay $0 to $100 copay Outpatient X-rays $15 to $110 copay $15 to $110 copay Radiation therapy $50 copay or 20% of the cost $50 copay or 20% of the cost HEARING SERVICES.
- How much you can expect to pay out of pocket for an mri, including what people paid. A spinal MRI is used to find various spinal problems, including nerve damage or tumors. It typically costs $1,000-$5,000, depending on the part of the spine being scanned and whether the procedure is performed in a hospital or physician's office.
2021 Medicare Advantage Plan Benefit Details for the Humana Gold Plus H0028-021 (HMO). Diagnostic radiology services (e.g., MRI): $0-275 copay (authorization.
Humana Mri Copay Application
Humana Copay Amounts
Copayments will be waived retroactively to March 18 for certain testing and office visits related to the testing. The test must be one approved, cleared, or authorized by the Food and Drug Administration to detect SARS-CoV-2 or diagnose COVID-19. If you paid any copayments for testing related to COVID-19 and the resulting office visits with a network or non- network provider, you may file a claim for reimbursement. For more information related to the coronavirus, visit the FAQ page.
| 2021 Medicare Advantage Plan Details | |||||
|---|---|---|---|---|---|
| Medicare Plan Name: | Humana Gold Plus H0028-021 (HMO) | ||||
| Location: | Pima, Arizona | ||||
| Plan ID: | H0028 - 021 - 0 Click to see other plans | ||||
| Member Services: | 1-800-457-4708 TTY users 711 | ||||
| — Enrollment Options — | |||||
| Medicare Contact Information: | 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 | ||||
Medicare plan advice at no cost from licensed insurance agents. Call: 888-205-9813 / TTY 711 Monday‐Friday 8am — 8pm ET | |||||
| Email a copy of the Humana Gold Plus H0028-021 (HMO) benefit details | |||||
| — Medicare Plan Features — | |||||
| Monthly Premium: | $0.00 (see Plan Premium Details below) | ||||
| Annual Deductible: | $0 | ||||
| Annual Initial Coverage Limit (ICL): | $4,130 | ||||
| Health Plan Type: | Local HMO | ||||
| Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $2,800 | ||||
| Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
| Total Number of Formulary Drugs: | 3,397 drugs | Browse the Humana Gold Plus H0028-021 (HMO) Formulary | |||
| This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
| This plan offers select insulin at a $35 copay. Learn more. | |||||
| Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
| • Preferred Pharmacy Cost-Sharing during initial coverage phase: | $2.00 | $10.00 | $42.00 | $95.00 | 33% |
| • Number of Drugs per Tier: | 304 | 600 | 773 | 1076 | 644 |
| Plan's Pharmacy Search: | http://www.humana.com/Medicare/medicare_prescription_drugs/ | ||||
| Plan Offers Mail Order? | Yes | ||||
| Number of Members enrolled in this plan in Pima, Arizona: | 11,430 members | ||||
| Number of Members enrolled in this plan in (H0028 - 021): | 14,462 members | ||||
| Plan’s Summary Star Rating: | 4 out of 5 Stars. | ||||
| • Customer Service Rating: | 4 out of 5 Stars. | ||||
| • Member Experience Rating: | 4 out of 5 Stars. | ||||
| • Drug Cost Accuracy Rating: | 4 out of 5 Stars. | ||||
| — Plan Premium Details — | |||||
| The Monthly Premium is Split as Follows:❔ | Total Premium | Part C Premium | Part D Base Premium | Part D Supplemental Premium | |
| $0.00 | $0.00 | $0.00 | $0.00 | ||
| Monthly Premium with Extra Help Low-Income Subsidy (LIS):❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
| Monthly Part D Premium with LIS: | $0.00 | $0.00 | $0.00 | $0.00 | |
| Total Monthly Premium with LIS (Parts C & D): | $0.00 | $0.00 | $0.00 | $0.00 | |
| — Plan Health Benefits — | |||||
| ** Base Plan ** | |||||
| Premium | |||||
| • Health plan premium: $0 | |||||
| • Drug plan premium: $0 | |||||
| • You must continue to pay your Part B premium. | |||||
| • Part B premium reduction: No | |||||
| Deductible | |||||
| • Health plan deductible: $0 | |||||
| • Other health plan deductibles: In-network: No | |||||
| • Drug plan deductible: No annual deductible | |||||
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | |||||
| • $2,800 In-network | |||||
| Optional supplemental benefits | |||||
| • Yes | |||||
| Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions? | |||||
| • In-network: No | |||||
| Doctor visits | |||||
| • Primary: $0 copay | |||||
| • Specialist: $30 copay per visit (authorization required) | |||||
| Diagnostic procedures/lab services/imaging | |||||
| • Diagnostic tests and procedures: $0-150 copay (authorization required) | |||||
| • Lab services: $0 copay (authorization required) | |||||
| • Diagnostic radiology services (e.g., MRI): $0-275 copay (authorization required) | |||||
| • Outpatient x-rays: $0-105 copay (authorization required) | |||||
| Emergency care/Urgent care | |||||
| • Emergency: $120 copay per visit (always covered) | |||||
| • Urgent care: $0-45 copay per visit (always covered) | |||||
| Inpatient hospital coverage | |||||
| • $180 per day for days 1 through 7 $0 per day for days 8 through 90 $0 per day for days 91 and beyond (authorization required) | |||||
| Outpatient hospital coverage | |||||
| • $20-180 copay per visit (authorization required) | |||||
| Skilled Nursing Facility | |||||
| • $0 per day for days 1 through 20 $178 per day for days 21 through 100 (authorization required) | |||||
| Preventive care | |||||
| • $0 copay | |||||
| Ground ambulance | |||||
| • $195 copay | |||||
| Rehabilitation services | |||||
| • Occupational therapy visit: $40 copay (authorization required) | |||||
| • Physical therapy and speech and language therapy visit: $40 copay (authorization required) | |||||
| Mental health services | |||||
| • Inpatient hospital - psychiatric: $312 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) | |||||
| • Outpatient group therapy visit with a psychiatrist: $20 copay (authorization required) | |||||
| • Outpatient individual therapy visit with a psychiatrist: $20 copay (authorization required) | |||||
| • Outpatient group therapy visit: $20 copay (authorization required) | |||||
| • Outpatient individual therapy visit: $20 copay (authorization required) | |||||
| Medical equipment/supplies | |||||
| • Durable medical equipment (e.g., wheelchairs, oxygen): 20% coinsurance per item (authorization required) | |||||
| • Prosthetics (e.g., braces, artificial limbs): 20% coinsurance per item (authorization required) | |||||
| • Diabetes supplies: $0 copay or 10-20% coinsurance per item (authorization required) | |||||
| Hearing | |||||
| • Hearing exam: $30 copay (authorization required) | |||||
| • Fitting/evaluation: $0 copay (limits apply, authorization required) | |||||
| • Hearing aids: $699-999 copay (limits apply) | |||||
| Preventive dental | |||||
| • Oral exam: $0 copay (limits apply) | |||||
| • Cleaning: $0 copay (limits apply) | |||||
| • Fluoride treatment: Not covered | |||||
| • Dental x-ray(s): $0 copay (limits apply) | |||||
| Comprehensive dental | |||||
| • Non-routine services: Not covered | |||||
| • Diagnostic services: Not covered | |||||
| • Restorative services: Not covered | |||||
| • Endodontics: Not covered | |||||
| • Periodontics: Not covered | |||||
| • Extractions: Not covered | |||||
| • Prosthodontics, other oral/maxillofacial surgery, other services: Not covered | |||||
| Vision | |||||
| • Routine eye exam: $0 copay (limits apply, authorization required) | |||||
| • Other: Not covered | |||||
| • Contact lenses: $0 copay (limits apply, authorization required) | |||||
| • Eyeglasses (frames and lenses): $0 copay (limits apply, authorization required) | |||||
| • Eyeglass frames: Not covered | |||||
| • Eyeglass lenses: Not covered | |||||
| • Upgrades: Not covered | |||||
| Wellness programs (e.g., fitness, nursing hotline) | |||||
| • Covered | |||||
| Transportation | |||||
| • $0 copay (limits apply, authorization required) | |||||
| Foot care (podiatry services) | |||||
| • Foot exams and treatment: $30 copay (authorization required) | |||||
| • Routine foot care: $0 copay (limits apply, authorization required) | |||||
| Medicare Part B drugs | |||||
| • Chemotherapy: 20% coinsurance (authorization required) | |||||
| • Other Part B drugs: 20% coinsurance (authorization required) | |||||
| Package #1 | |||||
| • Monthly Premium: $30.40 | |||||
| • Deductible: | |||||
| Package #2 | |||||
| • Monthly Premium: $40.10 | |||||
| • Deductible: |