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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 2025, 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 4 out of 5 stars in 2025.
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 $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 no drug deductible. Your prescription medication coverage will start immediately.
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 has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $5 copay for preferred generic drugs at a standard pharmacy or a preferred mail pharmacy, and 48% coinsurance for preferred brand drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H1468-013 (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, and outpatient services with varying copays depending on the service. This plan also includes coverage for services like emergency care, primary care, hearing, vision, and dental services, with specific copays and coinsurance amounts outlined for each. Additional benefits encompass preventive services with no copay for many services, and coverage for durable medical equipment, home health services, and skilled nursing facility stays with specific copays and coinsurance. The plan also offers over-the-counter items, and acupuncture treatments, but certain services like cardiac rehabilitation and additional hours of home health care are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $195 copay for days 1-7 and no copay for days 8-90 for acute care, and a $195 copay for days 1-7 and no copay for days 8-90 for psychiatric care. Additional days for Inpatient Hospital-Acute are covered with no copay. 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 include coverage for all outpatient hospital services, with a copay between $0 and $150, and observation services with a $195 copay. The plan also covers ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a copay between $10 and $100 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1468-013 (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H1468-013 (HMO), with a $315 copay for ground ambulance services and 20% coinsurance for air ambulance services. 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. 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
Primary Care Physician Services have no copay, while Chiropractic Services have no copay but require prior authorization and a doctor referral. Occupational Therapy Services have a $25 copay, and Physician Specialist Services have a $10 copay but require prior authorization and a doctor referral. Mental Health Specialty Services, including individual and group sessions, have a $10 copay, while Podiatry Services are not covered. Other Health Care Professional services have a copay between $0 and $10, and Psychiatric Services, including individual and group sessions, also have a $10 copay. Physical Therapy and Speech-Language Pathology Services have a $25 copay, Additional Telehealth Benefits have a copay between $0 and $65, and Opioid Treatment Program Services have a copay between $10 and $100.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services with a copay. Kidney disease education services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit all have no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $10 copay, and routine hearing exams are covered with no copay for one exam per year. Prescription hearing aids are partially covered, with copays between $699 and $999 for all types of prescription hearing aids, but not for inner, outer, or over-the-ear hearing aids. OTC hearing aids are covered up to $175 every three months.
Vision Services See details
The Humana Gold Plus H1468-013 (HMO) plan covers vision services, including routine eye exams with a copay between $0 and $10, and eyewear with a $0 copay and a combined maximum benefit of $300 per year. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $5,000 maximum plan benefit per year. Medicare dental services require prior authorization and a doctor referral, with a $10 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H1468-013 (HMO) plan, requiring prior authorization. Medicare Part B Insulin Drugs have a $35 copay and between 0% and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1468-013 (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 benefits are covered, including Durable Medical Equipment with 20% coinsurance and no copay, and Prosthetic Devices with 20% coinsurance and no copay. 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 are covered, including diagnostic procedures/tests with a copay between $0 and $65, lab services with no copay, diagnostic radiological services with a copay up to $195, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with no copay. All services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1468-013 (HMO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus H1468-013 (HMO) plan. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H1468-013 (HMO) plan. The copay is $20 for days 1-20, and $203 for days 21-100, with no coinsurance. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H1468-013 (HMO) plan covers acupuncture with a $10 copay and a limit of 20 treatments per year, and also provides over-the-counter items with a maximum benefit coverage of $175 every three months. This plan also offers a meal benefit with no copay for chronic illness, but other services like Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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