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Humana Gold Plus H2486-003 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H2486-003 (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 H2486-003 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H2486-003 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in UT. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H2486-003 (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 H2486-003 (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 H2486-003 (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 $200.00 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 $5600.00 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 H2486-003 (HMO) plan has a $200 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, the copay is $10 at a standard or mail-order pharmacy. For standard generic drugs, the copay is $47. For preferred brand drugs, you pay 50% coinsurance, and for non-preferred drugs, you pay 30% coinsurance. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The Humana Gold Plus H2486-003 (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Primary care visits, mental health services, and preventive services have no copay, while specialist visits and other services have copays. This plan includes coverage for ambulance services, emergency services, and home health services with copays or coinsurance. Vision, hearing, and dental services have limited coverage, with copays or coinsurance for specific services. Diagnostic and radiological services, as well as durable medical equipment, are covered with copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute care with a $500 copay for days 1-5, and no copay for days 6-90, as well as inpatient psychiatric care with a $458 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include Outpatient Hospital Services with a copay between $0 and $538, Observation Services with a $500 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $40 and $50 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 H2486-003 (HMO) plan, with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a $1250 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the Humana Gold Plus H2486-003 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $55 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus H2486-003 (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, occupational therapy services have a $30 copay, and physician specialist services have a $45 copay. Mental health and psychiatric services have no copay for individual or group sessions. Other health care professional services have a copay between $0 and $45. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a copay between $0 and $55, and opioid treatment program services have a copay between $40 and $50. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus H2486-003 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Fitness Benefit (Memory Fitness) with no copay. Other services such as health education, in-home safety assessment, and others are not covered.
Hearing Services See details
Humana Gold Plus H2486-003 (HMO) offers hearing exams with a $45 copay, but routine hearing exams, fitting/evaluation for hearing aids, and prescription and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$45, but routine eye exams are not covered. Eyewear benefits are covered with no copay, however, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H2486-003 (HMO) plan covers dental services with a $1,000 maximum benefit per year. Medicare dental services have a $45 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, and oral and maxillofacial surgery have no copay. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered. Prosthodontics (removable) has a 30% coinsurance and prosthodontics (fixed) has 30-40% coinsurance.
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. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H2486-003 (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with 6% coinsurance, Prosthetics/Medical Supplies with 6% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures and tests with a copay between $0 and $55, and lab services with no copay. Outpatient X-ray services have no copay, while diagnostic radiological services may have a copay up to $538, and therapeutic radiological services have at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H2486-003 (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, but the specific services Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and the copay information is detailed separately.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H2486-003 (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, for days 21-50 the copay is $214, and for days 51-100 there is no copay.
Other Services See details
Other Services includes 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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