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Humana Gold Plus H1951-049 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1951-049 (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 H1951-049 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1951-049 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Louisiana Parishes. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1951-049 (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 H1951-049 (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 H1951-049 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $5.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $590.00 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 $9350.00 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 H1951-049 (HMO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, you'll pay a $10.00 copay for preferred generic drugs at a standard pharmacy, or 48% coinsurance for preferred brand drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H1951-049 (HMO) plan offers coverage for a variety of healthcare services. This includes coverage for inpatient hospital stays with a copay, outpatient services, and emergency services. Additionally, the plan covers primary care visits with a $5 copay, hearing and vision services, and dental services with a maximum benefit. Preventive services, such as an annual physical exam, have no copay, and the plan also covers home health services, and skilled nursing facility care with a copay. Other benefits include ambulance services, medical equipment, and home infusion services. The plan also covers some diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, there is a $250 copay for days 1-10, and no copay for days 11-90; additional days have no copay. Inpatient Hospital Psychiatric has a $220 copay for days 1-10, and no copay for days 11-90; additional days are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $275, observation services with a $250 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $30 and $50 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H1951-049 (HMO) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H1951-049 (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, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services have a $45 copay; all have no coinsurance.
Primary Care See details
The Humana Gold Plus H1951-049 (HMO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, and occupational therapy services with a $20 copay. Additionally, the plan covers physician specialist services with a $45 copay, individual and group sessions for mental health and psychiatric services with a $30 copay, physical therapy and speech-language pathology services with a $20 copay, and opioid treatment program services with a minimum copay of $30 and a maximum copay of $50. Additional telehealth benefits are covered with a copay ranging from $0 to $45. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services, including Fitness Benefit, with a copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Some preventive services, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), and others, are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams are covered with no copay. Fitting/Evaluation for Hearing Aids has no copay, while prescription hearing aids are covered with a copay between $299 and $599, depending on the type. OTC hearing aids are not covered, and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are also not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$45, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, and have a combined maximum plan benefit of $250 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H1951-049 (HMO) plan covers a range of dental services with a maximum benefit of $1,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay, while restorative services, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay and 30-40% coinsurance. Fluoride treatments, 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 H1951-049 (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H1951-049 (HMO) plan and require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a 10%-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Gold Plus H1951-049 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, Therapeutic Radiological Services have a copay of at most $50 (minimum $35), and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1951-049 (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 H1951-049 (HMO) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H1951-049 (HMO), but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, with a $45 copay, and a meal benefit with no copay. Over-the-counter items, 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 are not covered.
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