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Humana Gold Plus H2463-001 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H2463-001 (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 H2463-001 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H2463-001 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Pinal and Yuma Counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H2463-001 (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 H2463-001 (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 H2463-001 (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 $5.00. 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 $225.00 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 $5250.00 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 H2463-001 (HMO) plan has an enhanced alternative drug benefit. The plan has a $225 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $15 copay for preferred generic drugs at a standard pharmacy, and 38% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase.
Additional Benefits
The Humana Gold Plus H2463-001 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services can have copays up to $360. Emergency services have a $125 copay, and primary care visits have no copay. Hearing and vision services are included, with hearing exams costing $30 and eye exams costing between $0 and $30. Dental services have no copay for many services, and the plan also offers additional benefits, such as coverage for acupuncture and an OTC allowance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute with a $360 copay for days 1-5, and no copay for days 6-90, and Inpatient Hospital Psychiatric with a $325 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. 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 includes coverage for all outpatient hospital services with a copay of $0-$360, observation services with a $360 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay 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 H2463-001 (HMO) plan. This benefit has a $100 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance services are covered by the Humana Gold Plus H2463-001 (HMO) plan, with no coinsurance, but with copays for both ground and air ambulance services. Ground ambulance services have a $315 copay, while air ambulance services have a $1250 copay, 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 H2463-001 (HMO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $55 copay, and both have no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all have a $125 copay, with no coinsurance.
Primary Care See details
The Humana Gold Plus H2463-001 (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $30 copay, and physical therapy and speech-language pathology services have a $30 copay. The plan also covers physician specialist services with a $30 copay, mental health and psychiatric services with a $40 copay, podiatry services with a $30 copay, other health care professional services with a copay ranging from $0 to $30, additional telehealth benefits with a copay from $0 to $55, and opioid treatment program services with a $40 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services that may have a copay, including: Medicare-covered Glaucoma Screening, Medicare-covered Diabetes Self-Management Training, Medicare-covered Barium Enemas, Medicare-covered Digital Rectal Exams, and Medicare-covered EKG following Welcome Visit, all with no copay. This plan also covers wigs for hair loss related to chemotherapy and fitness benefits with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, 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
The Humana Gold Plus H2463-001 (HMO) plan covers hearing services, including hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) having a copay between $299 and $899, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC Hearing Aids are covered up to $60 every three months.
Vision Services See details
The Humana Gold Plus H2463-001 (HMO) plan covers vision services, including eye exams with a copay between $0 and $30, and eyewear with no copay, up to a combined maximum of $150 per year. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H2463-001 (HMO) plan covers Medicare dental services with a $30 copay and other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H2463-001 (HMO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and Diabetic Supplies have a coinsurance between 10% and 20%; Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, lab services, and radiological services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $360, and Therapeutic Radiological Services have a coinsurance of 20% or more. Outpatient X-Ray Services have no copay.
Home Health Services See details
Humana Gold Plus H2463-001 (HMO) covers Home Health Services with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Humana Gold Plus H2463-001 (HMO) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H2463-001 (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214, with no coinsurance.
Other Services See details
The Humana Gold Plus H2463-001 (HMO) plan covers acupuncture with a $30 copay, up to 20 treatments per year, and also provides an Over-the-Counter (OTC) Items benefit with a maximum of $60 every three months. The plan also covers a meal benefit with no copay. However, the following services are not covered: 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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