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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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.00. 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 $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 $4900.00 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 a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions. For example, the copay for a standard generic drug is $10 at a preferred pharmacy and $20 at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. If you qualify for the low-income subsidy, you will pay no copay for your drugs.
Additional Benefits
The Humana Gold Plus H1951-049 (HMO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay of $195 per day for the first 10 days, with no copay for additional days, while outpatient services have copays that range from $0 to $175 depending on the service. Preventive services, routine eye exams, and many dental services come with no copay, but services like specialist visits and hearing exams have copays. The plan also provides coverage for emergency services, ambulance, and home health services, but it's important to review the specific copays and coinsurance associated with each service to understand the out-of-pocket costs.
Inpatient Hospital See details
Inpatient Hospital benefits for Humana Gold Plus H1951-049 (HMO) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For the first 10 days of an Inpatient Hospital-Acute or Inpatient Hospital Psychiatric stay, the copay is $195 per day, and there is no copay for days 11-90. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, along with Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include Outpatient Hospital Services with a copay of $0-$175, Observation Services with a $195 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse services with a copay of $30-$50 for individual and group sessions, and Outpatient Blood Services with no copay. These services may require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by 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. Ground ambulance services have a $315 copay, while air ambulance services have 20% coinsurance; however, 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 by the Humana Gold Plus H1951-049 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay.
Primary Care See details
Primary Care coverage includes no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services, and a $20 copay for Occupational Therapy Services. Physician Specialist Services have a $30 copay, while Mental Health Specialty Services and Psychiatric Services have a $30 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $20 copay, and Additional Telehealth Benefits have a copay between $0 and $55. Opioid Treatment Program Services have a copay between $30 and $50. Podiatry Services are not covered.
Preventive Services See details
The Humana Gold Plus H1951-049 (HMO) plan covers preventive services with no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additional preventive services, including health education, are not covered.
Hearing Services See details
Hearing services include hearing exams with a $30 copay, routine hearing exams (1 every year) with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $999, while OTC hearing aids are covered up to $60 every three months. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$30, and routine eye exams have no copay. Eyewear has no copay, and includes contact lenses and eyeglasses (lenses and frames), with a combined maximum of $350 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, and other dental services with a $2,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B insulin drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization required. Medicare Part B insulin drugs have a $35 copay and a coinsurance between 0% and 20%. Other services have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H1951-049 (HMO) plan, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies, including Medicare-covered Prosthetic Devices and Medical Supplies, with 20% coinsurance, and Diabetic Equipment, including Diabetic Supplies with 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $55, and lab services with no copay. Diagnostic Radiological Services have a copay up to $325, Therapeutic Radiological Services have a copay up to $50 (minimum $30), and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H1951-049 (HMO) 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 covered by Humana Gold Plus H1951-049 (HMO), but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H1951-049 (HMO) plan. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay.
Other Services See details
Humana Gold Plus H1951-049 (HMO) covers acupuncture with a $30 copay, and covers over-the-counter items up to $60 every three months, and covers a meal benefit with no copay. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, and the other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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