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Humana Gold Plus H2486-006 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H2486-006 (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 H2486-006 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H2486-006 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Snohomish County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H2486-006 (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 H2486-006 (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 H2486-006 (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 $5900.00 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 H2486-006 (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 used. For example, for a standard generic drug, you will pay a $10 copay at a standard pharmacy, and $20 copay at a mail order pharmacy. The plan also offers an enhanced alternative drug benefit.
Additional Benefits
The Humana Gold Plus H2486-006 (HMO) plan offers a range of benefits, including inpatient hospital care with a copay, outpatient services with varying cost-sharing, and emergency services with copays. This plan also covers primary care visits with no copay, along with preventive, hearing, vision, and dental services, with some cost-sharing requirements. Additionally, the plan includes coverage for ambulance, home health, skilled nursing facilities, and other services like acupuncture and a meal benefit, with specific copays, coinsurance, and prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $538 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric services have a $458 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute have 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 outpatient hospital services with a 20% coinsurance and a copay between $0 and $538, observation services with a $538 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a minimum of 20% and a maximum of 20% coinsurance and a copay between $50 and $50, and outpatient blood services with no copay. Prior authorization and a doctor's referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H2486-006 (HMO). Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a $1250 copay, and there is no coinsurance for either. 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 under the Humana Gold Plus H2486-006 (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay.
Primary Care See details
The Humana Gold Plus H2486-006 (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $45 copay. Physician specialist services have a $50 copay, and physical therapy and speech-language pathology services have a $45 copay. Additional telehealth benefits have a copay between $0 and $55. Opioid Treatment Program Services have a copay of $50 and a 20% coinsurance. Mental health and psychiatric individual and group sessions have no copay. Routine Chiropractic Care and podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus H2486-006 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, with a copay listed in the plan details.
Hearing Services See details
Hearing Services are partially covered by the Humana Gold Plus H2486-006 (HMO) plan. Hearing exams have a $50 copay, but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered. Eye exams have a copay between $0 and $50, but routine eye exams are not covered; eyewear has no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered under Humana Gold Plus H2486-006 (HMO), with a maximum benefit of $1000 per year. Medicare dental services require a $50 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics (removable and fixed) have no copay and coinsurance between 30% and 40%. Fluoride treatment, 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 H2486-006 (HMO) plan, with a copay of $35 for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H2486-006 (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered, with the plan covering Diabetic Supplies with 10%-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $55, while Lab Services and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of at most $538, and Therapeutic Radiological Services have at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H2486-006 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H2486-006 (HMO) plan, but require prior authorization and a doctor's referral. You will pay a $10 copay for days 1-20, $214 for days 21-50, and no copay for days 51-100. Additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) and non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
Other Services includes acupuncture, which has a $50 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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