A non-government entity
Humana Gold Plus H1468-007 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1468-007 (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 H1468-007 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1468-007 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Peoria and Rockford Illinois Metro Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1468-007 (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 H1468-007 (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 H1468-007 (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 $4.00. 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 $250.00 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 $3000.00 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:
Sign up for Humana Gold Plus H1468-007 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H1468-007 (HMO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, the copay is $5 at preferred and mail-order pharmacies, and $20 at standard pharmacies. For standard generic drugs, the copay is $47. Preferred brand drugs have a 50% coinsurance, and non-preferred drugs have a 30% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H1468-007 (HMO) plan offers a variety of benefits with varying costs. Hospital stays have a $270 copay for the first seven days, with no copay for longer stays, and outpatient services have copays ranging from $0 to $300. Emergency services require a $140 copay, and specialist visits cost $35. This plan includes no copay for primary care and preventive services such as annual physical exams. Hearing services include no copay for routine exams and fitting/evaluation for hearing aids. Vision services include no copay for routine eye exams. Dental services are covered with a $35 copay for Medicare dental services. Additional benefits include coverage for ambulance, home health, and skilled nursing services, with varying copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization and a doctor referral. For Inpatient Hospital-Acute, you'll pay a $270 copay for days 1-7, and no copay for days 8-90, with no coinsurance, and additional days 91-999 have no copay. For Inpatient Hospital Psychiatric, you'll pay a $270 copay for days 1-7, and no copay for days 8-90, with no coinsurance. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay between $0 and $300, and observation services with a $270 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have copays between $35 and $100 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1468-007 (HMO) plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Gold Plus H1468-007 (HMO) plan. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. 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 H1468-007 (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $65 copay, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
The Humana Gold Plus H1468-007 (HMO) plan covers primary care physician services and chiropractic services with no copay, but routine chiropractic care is not covered. Specialist services have a $35 copay, and mental health and psychiatric services have a $35 copay for individual and group sessions. Occupational therapy services have a $40 copay, and physical therapy and speech-language pathology services have a $40 copay. Additional telehealth benefits have a copay between $0 and $65, and opioid treatment program services have a copay between $35 and $100.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services, including Fitness Benefit with no copay. Some services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The Humana Gold Plus H1468-007 (HMO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $299 and $599, and OTC hearing aids are covered up to $125 every three months.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, and eyewear with a combined maximum plan benefit coverage of $100 per year. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) have no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, and other dental services with a $3,500 maximum benefit. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Restorative services have a 30% to 40% coinsurance and no copay, and Prosthodontics, removable has a 30% coinsurance and no copay. 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 by the Humana Gold Plus H1468-007 (HMO) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1468-007 (HMO) plan. You will pay 20% coinsurance for these services, and a doctor referral and prior authorization are required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies, and Diabetic Equipment. The plan covers Diabetic Supplies with a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, have a copay between $0 and $65, while Diagnostic Radiological Services have a copay of at most $350. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1468-007 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered by this plan.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H1468-007 (HMO) plan with a doctor referral and prior authorization required. For days 1-20, the copay is $20, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H1468-007 (HMO) plan covers acupuncture with a $35 copay, up to 20 treatments per year, and also covers over-the-counter items, up to $125 every three months, and meal benefits with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved