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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 2026, 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 2.5 out of 5 stars in 2026.
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.
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 a $615.00 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) prescription drug plan features an annual deductible of $615 before coverage begins. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications are also highly affordable, costing as low as a $9 copay for a 1-month supply, or no copay for a 3-month supply filled via preferred mail order. For Tier 3 preferred brand drugs, you can expect a $45 copay for a 1-month supply at standard pharmacies or through preferred mail order. Higher-tier prescriptions require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus H0783-004 (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist doctor visits require a $20 copay, while inpatient hospital stays have a $295 daily copay for the first six days and no copay for days seven through 90. Outpatient hospital services feature copays ranging from no copay up to $200, and diagnostic lab work and outpatient X-rays are covered with no copay. For additional care, this plan provides routine hearing and eye exams with no copay, alongside a $250 annual eyewear allowance and dental coverage up to a $2,000 yearly limit with no copay. Emergency room visits carry a $150 copay that is waived upon admission, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Members also benefit from covered acupuncture and meal benefits with no copay, though over-the-counter items and transportation services are not covered.
Inpatient Hospital See details
Humana Gold Plus H0783-004 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 copay per day for days 1 to 6 and no copay for days 7 to 90. Prior authorization and referrals are required for these benefits, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H0783-004 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay, and outpatient hospital services with a copay ranging from $0 to $200. Observation services require a $295 copay per stay, while outpatient substance abuse individual and group sessions carry a $20 to $35 copay, with prior authorization and referrals required for most services.
Partial Hospitalization See details
Humana Gold Plus H0783-004 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0783-004 (HMO) covers ambulance services with a $335 copay for ground transport and a 20% coinsurance for air transport, both of which require prior authorization. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H0783-004 (HMO) emergency services are covered with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0783-004 (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Other covered services like physical therapy, occupational therapy, and mental health services have copays ranging from $0 to $25 and no coinsurance, though podiatry and non-routine chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H0783-004 (HMO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs, with no copay and no coinsurance. Additional preventive services are partially covered, offering a memory fitness benefit with no copay and no coinsurance, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H0783-004 (HMO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $199 to $799 for up to two aids per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H0783-004 (HMO) with no coinsurance and a $0 to $20 copay for eye exams, which includes one routine annual exam with no copay. Covered eyewear has no copay and no coinsurance up to a $250 yearly limit for one pair of contacts or eyeglasses, but other eye exams, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H0783-004 (HMO), featuring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $2,000 annual maximum. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0783-004 (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while covered insulin requires a $35 copay that does not count toward the plan deductible and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H0783-004 (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required for these services.
Medical Equipment See details
Humana Gold Plus H0783-004 (HMO) covers durable medical equipment and prosthetic devices with a 20% coinsurance and no copay. Covered diabetic supplies require a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts are covered with a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H0783-004 (HMO) covers diagnostic and radiological services with no coinsurance for diagnostic services, no copay for lab work or outpatient X-rays, and diagnostic test copays ranging from $0 to $100. Therapeutic radiological services require a minimum $20 copay and 20% coinsurance, and prior authorization and referrals are required for these services.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H0783-004 (HMO) plan with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0783-004 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, but only some services are covered in practice. Specifically, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus H0783-004 (HMO) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus H0783-004 (HMO) provides partial coverage for other services, offering acupuncture up to 25 treatments per year and qualifying meal benefits with no copay, no coinsurance, and prior authorization requirements. Over-the-counter (OTC) items are not covered under this plan.
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