Consumer app
Your coverage workspace
Humana Gold Plus
Humana · gold · Humana PPO
Individual deductible
$1,200
Family deductible
$2,400
Individual OOP max
$5,000
Family OOP max
$10,000
Primary care copay
$20
Specialist copay
$45
ER copay
$275
Coinsurance
$0
Rx generic
$8
Rx brand
$40
Rx specialty coins.
25%
Coverage matrix
Rx tiers, prior auth, mental health, maternity, rehab, DME, telehealth
Rx · Generic (Tier 1)
Low copay; mail-order 90-day often available.
Rx · Preferred brand (Tier 2)
Preferred brand copay; step therapy uncommon for preferred list.
Rx · Non-preferred brand (Tier 3)
Non-preferred brands typically need exception or higher cost-share.
Rx · Specialty (Tier 4)
Specialty drugs almost always require prior authorization + specialty pharmacy.
Prior authorization
Imaging, specialty Rx, some surgeries, and DME commonly require PA.
Mental health & substance use
Parity with medical; tele-behavioral health included.
Maternity & newborn
Prenatal, delivery, and newborn covered as EHB; confirm OB network.
Rehab & physical therapy
Outpatient PT/OT/ST; visit limits vary by plan year.
Durable medical equipment (DME)
DME typically coinsurance after deductible; prior auth for higher-cost items.
Telehealth
Telehealth available; cost-share may mirror office visits.
What IS covered
- Preventive care at $0
- Chronic care management
- Home health (limited)
What is NOT covered
Clear callouts — never buried in footnotes
- ✕Adult hearing aids
- ✕Cosmetic dental
Network snapshot · ZIP 75201
Humana PPO
10
Hospitals
170
Primary care
400
Specialists
Filed facility prices vs modeled member share
Side-by-side for Humana Gold Plus — hospital shoppable-service filed charges in the selected metro versus modeled plan cost-share for comparable episodes. Not live quotes; not insurance advice; not an EOB.
Transparency metro
Dallas, TX · 75201
Switch curated hospital shoppable-service samples by metro. Educational data — not live MRF crawls or quotes; not insurance advice.
Comparing against transparency samples for Dallas, TX · 75201 (Dallas–Fort Worth (demo)).
| Service | Filed hospital charge Filed | Modeled member share Modeled |
|---|---|---|
MRI brain without & with contrast CPT-ish 70553 Comparable to medium-utilizer outpatient imaging (DEMO_SCENARIOS moderate MRI). | $1,920 Parkland Memorial Hospital Filed Median of 2 filed samples in ZIP | $1,920 Plan pays ~$0 (model) Modeled Deductible + coins Deductible engaged Fresh-deductible episode model using filed charge as allowed amount — educational only. |
Emergency department visit, moderate severity CPT-ish 99284 Modeled as plan ER copay (DEMO_SCENARIOS heavy includes an ER visit). | $1,280 Parkland Memorial Hospital Filed Median of 2 filed samples in ZIP | $275 Plan pays ~$1,005 (model) Modeled ER copay Plan ER copay model — not an EOB; facility charge ≠ member bill. |
Colonoscopy, diagnostic CPT-ish 45378 Isolated outpatient procedure through deductible + coinsurance. | $2,750 Methodist Dallas Medical Center Filed Median of 2 filed samples in ZIP | $2,470 Plan pays ~$280 (model) Modeled Deductible + coins Deductible engaged Fresh-deductible episode model using filed charge as allowed amount — educational only. |
Physical therapy evaluation CPT-ish 97161 Comparable to medium-utilizer PT (per-evaluation illustration; not an 8-visit bundle). | $195 Parkland Memorial Hospital Filed Median of 2 filed samples in ZIP | $195 Plan pays ~$0 (model) Modeled Deductible + coins Deductible engaged Fresh-deductible episode model using filed charge as allowed amount — educational only. |
Vaginal delivery CPT-ish 594 Isolated inpatient-style allowed amount through deductible + coinsurance. | $16,200 Methodist Dallas Medical Center Filed Median of 2 filed samples in ZIP | $5,160 Plan pays ~$11,040 (model) Modeled Deductible + coins Deductible engaged Fresh-deductible episode model using filed charge as allowed amount — educational only. |
Modeled shares assume an isolated episode (fresh deductible) using the filed charge as the allowed amount, or the plan's ER copay for ED visits. Filed columns are curated CMS shoppable-style samples (not a live hospital crawl). Facility list prices are not the same as negotiated rates or member bills. Not live quotes; not insurance advice. See Trust & compliance.
Search drugs & procedures
Find shoppable services by name or code in Dallas, TX · 75201. Facility charges labeled Filed; plan member share labeled Modeled when a plan is selected. Curated sample — not a live crawl. Not live quotes; not insurance advice.
Modeling member share with Humana Gold Plus — educational estimate only.
Try a CPT/HCPCS code (e.g. 70553, J1100) or a name like MRI, colonoscopy, chest X-ray, metabolic, or dexamethasone.
Filed = illustrative CMS shoppable / transparency-style facility charges (curated sample, not a live hospital crawl). Modeled = educational plan member-share estimate when a plan is selected (deductible + coinsurance or ER copay). Not live quotes. Not an EOB. Not insurance or medical advice.
Facility price transparency
Shoppable-service style facility charges by metro — every row labeled filed or modeled. Not live quotes; not insurance advice.
Transparency metro
Dallas, TX · 75201
Switch curated hospital shoppable-service samples by metro. Educational data — not live MRF crawls or quotes; not insurance advice.
Showing Dallas, TX (Dallas–Fort Worth (demo)). Demo Dallas household is fictional sample data — not a real member record.
| Facility | Charge | Provenance |
|---|---|---|
Parkland Memorial Hospital Chest X-ray, 2 views · 71046 | $265 | Filed |
Methodist Dallas Medical Center Chest X-ray, 2 views · 71046 | $390 | Modeled |
Baylor University Medical Center Chest X-ray, 2 views · 71046 | $420 | Filed |
Methodology & honesty labels
Parity facility price transparency (increments 2–6) WHERE NUMBERS COME FROM • CMS Hospital Price Transparency rules require hospitals to publish machine-readable files (MRFs) and a consumer shoppable-services list (typically ≥300 services) with gross charges, discounted cash prices, and payer-specific negotiated rates where applicable. Our "filed" samples are curated illustrative rows in that conceptual shape (CPT-ish shoppable services: MRI, ED visit, colonoscopy, childbirth, PT, chest X-ray, CT head, CMP lab, plus facility-administered Rx HCPCS e.g. J1100), not a live ingest of any hospital's MRF at runtime. • ZIP scopes in this demo: Dallas 75201 (primary), Maine 03904 (example), plus NYC 10001, Chicago 60611, Los Angeles 90012, Atlanta 30303, and Denver 80202. The Dallas household in demo-data is fictional — not any real user's PHI. • Bundled CMS MRF sample loader (cmsMrfSampleLoader): read-only ingest of a small in-repo JSON/CSV fixture shaped like simplified shoppable rows. Explicitly labeled "sample file / not live crawl" — never a live hospital crawl or live quote. WHAT IS MODELED • "modeled" rows are educational estimates (metro medians / relative adjustments) used when we lack a filed-style sample for that facility×service. They are labeled modeled in every API and UI surface. • Plan cost-share estimates elsewhere in Parity (deductible / coinsurance / OOP) remain separate modeled member-cost scenarios — not facility list prices. PLAN DETAIL (increment 3) • On /app/health/[planId], filed facility shoppable charges for the selected metro ZIP are shown side-by-side with modeled plan member cost-share (deductible + coinsurance or ER copay). See healthFiledVsModeled.ts. Badges remain Filed vs Modeled. DRUG / PROCEDURE SEARCH (increment 4) • Search box on /app/health (and transparency panel) matches shoppable services by name or code against the curated transparency dataset for the selected metro ZIP (parity_health_zip). Results list filed facility prices with Filed/Modeled badges; when a plan context is selected, a modeled member-share estimate is shown — otherwise a clear "no plan selected" note. See healthTransparencySearch.ts. • Dataset remains curated/illustrative — not fake live feeds. FAVORITES / ANNUAL CARE (increments 5–6) • Users can favorite procedures/drugs from search or the facility panel; favorites persist on the household via AppState → localStorage (parity_app_v1). The health hub favorites list re-runs filed prices for the selected metro ZIP. • Annual care scenario bundles primary care / PT / imaging / lab / Rx admin (plus optional favorites) into plan × estimated yearly member cost using filed facility prices + modeled cost-share. Increment 6 adds pediatric and pregnancy presets and clipboard/printable export of plan × estimated yearly member cost. See healthFavorites.ts and healthAnnualScenario.ts. HONESTY • Never treat these as live quotes, guarantees, or insurance advice. • Always surface provenance badges: filed vs modeled. • Sample MRF path uses parseCmsLikeJson / parseCmsLikeCsv → normalizeCmsLikeRow; source badge must read sample file / not live crawl. • Metro ZIP picker (7 scopes) is first-class on /app/health; optional localStorage key parity_health_zip persists the selection.
Sample file / not live crawl — bundled fixture shaped like simplified CMS hospital price transparency shoppable rows. Parser demo only; not a live hospital MRF fetch, not live quotes, and not insurance advice.
See also Trust & compliance.
Annual care scenario
Sample yearly bundle for Dallas, TX · 75201 — filed facility prices where available + modeled plan cost-share. Not insurance advice; not live quotes (sample dataset, not a live crawl).
Adult (default) bundle
Primary care, PT, MRI, lab, and facility-admin Rx for a typical adult year.
- Primary care office visits ×2 (plan copay · Modeled)
- Physical therapy evaluation, low complexity
- MRI brain without & with contrast
- Comprehensive metabolic panel
- Injection, dexamethasone sodium phosphate, 1 mg
Export plan × estimated yearly member cost (clipboard / print)
Loading plan estimates…
Printable export — Adult (default)
Dallas, TX · 75201 · plan × estimated yearly member cost · Filed / Modeled honesty
Parity — Annual care scenario Metro / ZIP: Dallas, TX · 75201 Scenario: Adult (default) [adult] Bundle: Primary care office visits ×2; Physical therapy evaluation, low complexity; MRI brain without & with contrast; Comprehensive metabolic panel; Injection, dexamethasone sodium phosphate, 1 mg Plan × estimated yearly member cost (sorted low → high): 1. Humana Gold Plus (Humana · gold) Premium: $9,240 Est. care share: $2,272 Est. annual member: $11,512 Labels: Filed ×4 · Modeled ×5 Filed / Modeled: Estimated annual member cost = plan premium + educational care cost-share for this sample bundle. Filed = curated CMS shoppable-style facility charges for the selected metro ZIP (sample, not a live crawl). Modeled = plan deductible/coinsurance/copay applied to those charges (or PCP copay when no facility row). Not live quotes. Not an EOB. Not insurance or medical advice. Methodology: curated CMS shoppable-style filed facility charges (sample, not a live crawl) + modeled plan deductible/coinsurance/copay for a shared plan year — educational estimate only; not advice. Not insurance or medical advice. Sample dataset — not a live hospital crawl. Not a quote or EOB.
Methodology: curated CMS shoppable-style filed facility charges (sample, not a live crawl) + modeled plan deductible/coinsurance/copay for a shared plan year — educational estimate only; not advice.
Bundle line items & honesty labels
Services in this run: Primary care office visits (×2) · Physical therapy evaluation, low complexity · MRI brain without & with contrast · Comprehensive metabolic panel · Injection, dexamethasone sodium phosphate, 1 mg
- Primary care office visitsModeled
Member ~$40 — Plan primary-care copay × visits — no facility filed row; educational only.
- Physical therapy evaluation, low complexityFiledModeled
Filed allowed ~$195 · Member ~$195 — Filed charge as allowed amount through shared-year deductible + coinsurance.
- MRI brain without & with contrastFiledModeled
Filed allowed ~$1,920 · Member ~$1,920 — Filed charge as allowed amount through shared-year deductible + coinsurance.
- Comprehensive metabolic panelFiledModeled
Filed allowed ~$95 · Member ~$95 — Filed charge as allowed amount through shared-year deductible + coinsurance.
- Injection, dexamethasone sodium phosphate, 1 mgFiledModeled
Filed allowed ~$22 · Member ~$22 — Facility-administered Rx charge through shared-year deductible + coinsurance — not retail pharmacy copay.
Estimated annual member cost = plan premium + educational care cost-share for this sample bundle. Filed = curated CMS shoppable-style facility charges for the selected metro ZIP (sample, not a live crawl). Modeled = plan deductible/coinsurance/copay applied to those charges (or PCP copay when no facility row). Not live quotes. Not an EOB. Not insurance or medical advice.
Cost by utilizer scenario
Low / medium / high utilizer · family size 3 · premium + member medical/Rx
Low utilizer
$9,592
Care $352
Medium utilizer
$12,096
Care $2,856
High utilizer
$17,081
Care $7,841
Low utilizer — wellness + minor care
$9,592
- Primary care visits$40
- Annual labs$280
- Generic Rx$32
Medium utilizer — specialist + imaging
$12,096
- Primary care visits$60
- Specialist visits$180
- MRI (outpatient)$1,800
- Physical therapy (8 visits)$672
- Generic Rx$64
- Brand Rx$80
High utilizer — surgery + ER
$17,081
- Primary care visits$80
- Specialist visits$270
- ER visits$275
- Outpatient surgery$4,720
- Follow-up imaging$240
- Generic Rx$96
- Brand Rx$160
- Specialty Rx (member share)$2,000