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Humana Gold Plus H0783-004 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0783-004 (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 H0783-004 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0783-004 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Crosby, Hale, Hockley, Lubbock and Lynn counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0783-004 (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 H0783-004 (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 H0783-004 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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 a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3950.00 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 H0783-004 (HMO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $9 copay for preferred generic drugs at a standard pharmacy, and 40% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, those with low income subsidy (LIS) will pay no cost for Part D drugs. Please check the plan's formulary for specific drugs covered.
Additional Benefits
The Humana Gold Plus H0783-004 (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for many services, such as primary care visits, preventive services, routine hearing exams, eyewear, and many dental services. It also covers inpatient hospital stays, outpatient services, emergency services, and more, with varying copays and coinsurance amounts depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care, with a $295 copay for days 1-6 and no copay for days 7-90. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $200, Observation Services have a $295 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse have a minimum copay of $20 and a maximum copay of $50. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0783-004 (HMO) plan, but requires prior authorization. You will pay a $45 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H0783-004 (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $65 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $140 copay.
Primary Care See details
The Humana Gold Plus H0783-004 (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $30 copay, Mental Health Specialty Services, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. This plan also offers additional telehealth benefits with a copay between $0 and $65, and covers Opioid Treatment Program Services with a copay between $20 and $50.
Preventive Services See details
Preventive Services include no copay for an annual physical exam, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a welcome visit. Additional preventive services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $30 copay, including Medicare-covered benefits and routine hearing exams. Routine hearing exams are covered once per year with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H0783-004 (HMO) plan covers vision services, including routine eye exams with a copay of $0-$30, and eyewear. Eyewear benefits include contact lenses and eyeglasses (lenses and frames) with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $30 copay, and other dental services with a $1,500 annual maximum benefit. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics (fixed) are covered with no copay. Fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B drugs, and Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0783-004 (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, is covered. Durable Medical Equipment has a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 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 include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests and lab services. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay, while all radiological services are covered with a copay for Medicare-covered diagnostic and therapeutic radiological services, and X-Ray services.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0783-004 (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered under this plan. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H0783-004 (HMO) plan, but require prior authorization and a doctor's referral. You will pay a copay of $20 for days 1-20, and $214 for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H0783-004 (HMO) plan covers acupuncture with a $30 copay, and covers a meal benefit with no copay. Other services such as over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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