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Humana Gold Plus H1468-013 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1468-013 (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 H1468-013 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H1468-013 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Cook, DuPage, Kankakee, Lake, and Will counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H1468-013 (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 H1468-013 (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 H1468-013 (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 $1.00. 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 $2150.00 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 H1468-013 (HMO) plan features a yearly prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for 1-month and 3-month supplies at standard pharmacies or through preferred mail order. Tier 2 generic medications cost a $5 copay for a 1-month supply at standard pharmacies, and there is no copay for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs have a $47 copay for a 1-month supply at standard pharmacies and mail order services. Tier 4 non-preferred drugs require a 48% coinsurance, while Tier 5 specialty tier drugs carry a 25% coinsurance for a 1-month supply. These structured copayments and coinsurance rates help you manage your healthcare budget with this Humana Medicare Advantage plan.
Additional Benefits
The Humana Gold Plus H1468-013 (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits and routine annual physicals. Specialists are highly accessible with a low $10 copay, while inpatient hospital stays require a $195 daily copay for the first seven days and no copay for days eight through 90. Outpatient hospital services range from no copay to a $200 copay, and emergency room visits carry a $150 copay which is waived if you are admitted. This plan also provides comprehensive dental, vision, and hearing benefits to help you save on everyday healthcare needs. You will pay no copay for routine eye exams, eyewear up to a $300 limit, and most preventive dental care up to a generous $5,000 annual limit. Additionally, routine hearing exams and over-the-counter hearing aids require no copay, while prescription hearing aids are covered with copays ranging from $699 to $999.
Inpatient Hospital See details
Humana Gold Plus H1468-013 (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $195 daily copay for days 1 through 7 and no copay for days 8 through 90. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H1468-013 (HMO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $200 copay ($195 per stay for observation), and outpatient substance abuse sessions have a $20 to $35 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus H1468-013 (HMO) plan 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 H1468-013 (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. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H1468-013 (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have 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 H1468-013 (HMO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $10 copay and no coinsurance. Other services like physical therapy and mental health require copays of $20 to $25 with no coinsurance, while chiropractic care is partially covered (routine chiropractic is not covered) and podiatry is not covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus H1468-013 (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, and select screenings. Uncovered services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
Humana Gold Plus H1468-013 (HMO) covers hearing services, including Medicare-covered exams for a $10 copay and routine exams, fittings, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two devices per year, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Humana Gold Plus H1468-013 (HMO) vision services are partially covered, offering routine eye exams and eyewear with no copay, no coinsurance, and no deductible. Covered benefits include one routine exam and one pair of contacts or eyeglasses per year up to a $300 limit, while other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1468-013 (HMO) partially covers dental services up to a $5,000 annual limit, featuring no copay and no coinsurance for most preventive, diagnostic, and restorative care, alongside Medicare-covered dental services for a $10 copay and no coinsurance. While prosthodontics require a 30% coinsurance and no copay, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1468-013 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Medicare Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H1468-013 (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
Humana Gold Plus H1468-013 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H1468-013 (HMO) covers diagnostic services with no coinsurance, offering lab services at no copay and diagnostic procedures with a copay ranging from $0 to $65. Radiological services are also covered, featuring no copay for outpatient X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Humana Gold Plus H1468-013 (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
Cardiac Rehabilitation Services are covered by Humana Gold Plus H1468-013 (HMO) with no coinsurance and a copay ranging from no copay to $10. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1468-013 (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus H1468-013 (HMO), featuring acupuncture for a $10 copay and no coinsurance (up to 20 treatments per year) and both over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and certain other services are not covered.
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