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Humana Gold Plus Giveback H1468-021 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1468-021 (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 Giveback H1468-021 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus Giveback H1468-021 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Chicago (Cook, DuPage, Lake, Will). This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus Giveback H1468-021 (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 Giveback H1468-021 (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 Giveback H1468-021 (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 $60.00. 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 $4150.00 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 Giveback H1468-021 (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 the pharmacy you use. For example, you will pay a $5 copay at a standard pharmacy for preferred generic drugs, and 46% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Gold Plus Giveback H1468-021 (HMO) plan offers a range of benefits, including inpatient hospital stays with a $350 copay for the first six days, and no copay for days 7-90. Outpatient services have varying copays, and emergency services have a $140 copay. The plan also covers primary care and preventive services with no copay, while specialist visits and physical therapy have a $35 copay. Additional benefits include hearing exams with a $35 copay, and prescription hearing aids with copays ranging from $299-$599. Vision services include eye exams with a copay of $0-$35 and eyewear with no copay. Dental services include coverage for Medicare Dental Services with a $35 copay and other dental services up to a $3,500 annual maximum. The plan also covers home infusion, medical equipment with 20% coinsurance, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered with a $350 copay for days 1-6, and no copay for days 7-90; additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay of $0-$250. Observation Services have a $350 copay, while Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services include individual sessions with a copay of $35-$100, and group sessions with a copay of $35-$100. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus Giveback H1468-021 (HMO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a 20% coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus Giveback H1468-021 (HMO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $65 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay, and no coinsurance.
Primary Care See details
The Humana Gold Plus Giveback H1468-021 (HMO) plan covers primary care physician services and chiropractic services with no copay, while occupational therapy services have a $35 copay. Physician specialist services, mental health specialty services, and psychiatric services have a $35 copay. Physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $0 and $65, and Opioid Treatment Program Services have a copay between $35 and $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Kidney Disease Education Services, and other services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams are covered with no copay for one exam per year. Prescription hearing aids are partially covered, with no coverage for inner ear, outer ear, and over the ear hearing aids, but with a $299-$599 copay for all other types of hearing aids. OTC hearing aids are covered up to $125 every three months.
Vision Services See details
Vision services include eye exams with a copay of $0-$35, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, with a combined maximum plan benefit of $150 per year. 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 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Prosthodontics (removable and fixed) are covered with no copay and 30% coinsurance, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus Giveback H1468-021 (HMO) plan and require prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies - Non-Medicare benefit with coinsurance, and Diabetic Equipment with varying cost-sharing depending on the specific supply or service. 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 include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $65, lab services with no copay, diagnostic radiological services with a copay up to $350, therapeutic radiological services with at least 20% coinsurance, and outpatient X-ray services with no copay. Prior authorization and a doctor referral are required for all services.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus Giveback H1468-021 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus Giveback H1468-021 (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. For days 1-20, there is a $20 copay, and for days 21-100, there is a $203 copay.
Other Services See details
The Humana Gold Plus Giveback H1468-021 (HMO) plan covers acupuncture with a $35 copay, and covers up to 20 treatments per year; it also covers Over-the-Counter (OTC) items up to $125 every three months, including nicotine replacement therapy and naloxone, and covers a meal benefit with no copay. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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