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Humana Gold Plus H0783-002 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0783-002 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H0783-002 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0783-002 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Cameron, Hidalgo and Willacy counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0783-002 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus H0783-002 (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Gold Plus H0783-002 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Gold Plus H0783-002 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, you'll pay no copay for preferred generic drugs at a preferred pharmacy, while standard generic drugs have a $30 copay at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy. Be sure to check the plan's formulary for specific drugs covered.
Additional Benefits
The Humana Gold Plus H0783-002 (HMO) plan offers a range of benefits, including inpatient hospital stays with a $350 copay per admission, and outpatient services with varying copays depending on the specific service. You'll find no copays for services like primary care visits, routine eye exams, and many dental services, as well as coverage for ambulance and transportation services. The plan also covers emergency services, preventive services, and offers hearing, vision, and dental benefits, with specific copays and coinsurance amounts depending on the service. Additional benefits include home health services with no copay, and medical equipment with a 20% coinsurance for DME, Prosthetics/Medical Supplies, and a 10-20% coinsurance for Diabetic Supplies.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $350 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $300, Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $25 and $100, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral are required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by Humana Gold Plus H0783-002 (HMO), but requires prior authorization. You will have a $35 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H0783-002 (HMO). Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation Services to plan-approved health-related locations are covered with no copay, up to 48 one-way trips per year, and include transportation such as taxi, bus/subway, and medical transport. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H0783-002 (HMO) plan. Emergency Services have a $140 copay with no coinsurance, Urgently Needed Services have a $65 copay with no coinsurance, and Worldwide Emergency Services (including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation) have a $140 copay with no coinsurance.
Primary Care See details
The Humana Gold Plus H0783-002 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $20 copay. Additionally, it covers physician specialist services, mental health specialty services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services, all with varying copays. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus H0783-002 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, including Fitness Benefit (Memory Fitness) with no copay, while other services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
The Humana Gold Plus H0783-002 (HMO) plan covers hearing exams with a $20 copay and routine hearing exams with no copay for one visit per year, as well as fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types of prescription hearing aids, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $20, with routine eye exams covered with no copay. Eyewear is covered, including contact lenses and eyeglasses, both with no copay, and a combined maximum plan benefit of $250 per year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H0783-002 (HMO) plan covers Medicare Dental Services with a $20 copay, and also covers other dental services up to a $2,500 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with no copay and varying coinsurance and visit limits, while fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0783-002 (HMO) plan. A doctor referral and prior authorization are required, and the coinsurance is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. For DME, you will pay 20% coinsurance, and for Prosthetic Devices and Medical Supplies, you will also pay 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services and all radiological services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $65, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $325, Therapeutic Radiological Services have a copay of $20 to $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0783-002 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
The Humana Gold Plus H0783-002 (HMO) plan covers Skilled Nursing Facility (SNF) services with a $20 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Gold Plus H0783-002 (HMO) plan covers acupuncture with a $20 copay and a limit of 20 treatments per year, and also offers a meal benefit with no copay. Other services, including over-the-counter items, are not covered.
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