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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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 $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 $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:
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Drug Coverage
The Humana Gold Plus H1468-007 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, requiring a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, or no copay for a 3-month supply via preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply. Higher-tier medications transition to coinsurance, with Tier 4 non-preferred drugs requiring a 47% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The Humana Gold Plus H1468-007 (HMO) plan offers robust medical coverage, including primary care doctor visits and preventive services with no copay or coinsurance. Specialist visits require a $25 copay, while inpatient hospital stays require a $295 daily copay for the first seven days and no copay for days eight through ninety. Emergency room visits carry a $150 copay, which is waived if you are admitted, and urgent care services require a $65 copay. This plan also features strong supplemental benefits, including a $3,000 annual maximum for dental care with no copay for most preventive and comprehensive services. Routine vision and hearing exams are covered with no copay, and prescription hearing aids are available with copays ranging from $699 to $999. Additionally, beneficiaries pay no copay for home health services and over-the-counter items, while durable medical equipment requires a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H1468-007 (HMO) covers inpatient hospital services with no coinsurance, requiring a $295 daily copay for days 1 through 7 and no copay for days 8 through 90. This benefit is partially covered, as unlimited additional acute care days are included with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H1468-007 (HMO) with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $295 copay per stay for observation services. There is no copay for ambulatory surgical center or blood services, while outpatient substance abuse sessions require a $30 to $35 copay.
Partial Hospitalization See details
Humana Gold Plus H1468-007 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H1468-007 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H1468-007 (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay 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 covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1468-007 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Physical, occupational, and speech therapies require a $40 copay and no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H1468-007 (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, and memory fitness. However, these additional preventive services are only partially covered, as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H1468-007 (HMO) covers hearing services with a $25 copay and no coinsurance for Medicare-covered exams, while routine exams, fitting evaluations, and OTC hearing aids have no copay or coinsurance. Prescription hearing aids are partially covered for up to two devices per year with no coinsurance and copays ranging from $699 to $999, though inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Humana Gold Plus H1468-007 (HMO) partially covers vision services with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam and a $100 annual combined limit for one pair of contact lenses or eyeglasses (lenses and frames) per year, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1468-007 (HMO) offers partially covered dental services with a $3,000 annual maximum, featuring a $25 copay and no coinsurance for Medicare-covered dental services. Most preventive and comprehensive services, including exams, cleanings, and oral surgery, have no copay and no coinsurance, though prosthodontics require a 30% coinsurance with no copay, and fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1468-007 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs have no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H1468-007 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive coverage for these services.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H1468-007 (HMO), with durable medical equipment, medical supplies, and prosthetic devices requiring a 20% coinsurance and no copayment. Covered diabetic supplies have a 10% to 20% coinsurance with no copayment, while diabetic therapeutic shoes and inserts require a $10 copayment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H1468-007 (HMO) with no coinsurance for diagnostic services, no copay for lab work or outpatient X-rays, and a copay of $0 to $65 for diagnostic procedures. Diagnostic radiological services have no copay (minimum $0), while therapeutic radiological services require a minimum 20% coinsurance, with referrals and prior authorizations required.
Home Health Services See details
Humana Gold Plus H1468-007 (HMO) covers home health services 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 H1468-007 (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, although prior authorization and a referral are required. While some services are covered, specific sub-services including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H1468-007 (HMO) with no coinsurance, requiring a $20 copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1468-007 (HMO) partially covers other services, including acupuncture with a $25 copay and no coinsurance for up to 20 treatments per year. Over-the-counter (OTC) items and chronic illness meal benefits are also covered with no copay and no coinsurance, though some miscellaneous services under this category are not covered.
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