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Humana Gold Plus H2486-007 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H2486-007 (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 H2486-007 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H2486-007 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Clark 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 H2486-007 (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 H2486-007 (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 H2486-007 (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 $2.00. 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 H2486-007 (HMO) plan has a $200.00 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, standard generic drugs have a $47 copay, while preferred brand drugs have 50% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, and you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you may have reduced costs for your prescriptions.
Additional Benefits
The Humana Gold Plus H2486-007 (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with varying copays depending on the length of stay, and outpatient services with copays and coinsurance. The plan also covers emergency services, primary care, preventive services, and dental services with a $1,000 annual maximum. Additional benefits include coverage for ambulance services, partial hospitalization, hearing and vision services, and home health services with no copay. The plan also covers skilled nursing facility services with copays that vary by the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $538 for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $458 for days 1-5, and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stay and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a 20% coinsurance and a copay between $0 and $538, and observation services with a $538 copay per stay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a minimum of 20% coinsurance and a $5 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H2486-007 (HMO) plan, but requires prior authorization. You will pay a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H2486-007 (HMO). Ground Ambulance Services have a $315 copay, and Air Ambulance Services have a $1250 copay, but Transportation Services to a health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services and Urgent Care, are covered by the Humana Gold Plus H2486-007 (HMO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services require a referral and prior authorization, with a $20 copay. Occupational Therapy Services are covered with a $45 copay and require prior authorization and a referral. Physician Specialist Services require a referral and prior authorization, with a $50 copay. Mental Health Specialty Services, including individual and group sessions, are covered with no copay. Other Health Care Professional services have a copay between $0 and $50, and require prior authorization. Psychiatric Services, including individual and group sessions, are covered with no copay and require prior authorization. Physical Therapy and Speech-Language Pathology Services are covered with a $45 copay, and require a referral and prior authorization. Additional Telehealth Benefits are covered with a copay between $0 and $55. Opioid Treatment Program Services require a referral and prior authorization, with a 20% coinsurance and a $5 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, an annual physical exam with no copay, kidney disease education services with no copay, and other preventive services including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. Additional preventive services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services are partially covered by the Humana Gold Plus H2486-007 (HMO) plan. Hearing exams have a $50 copay, while routine hearing exams, fitting/evaluation for hearing aid, 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 include eye exams with a copay between $0 and $50, but routine eye exams are not covered. Eyewear is covered with no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H2486-007 (HMO) plan offers dental services with a $1,000 annual maximum, with a $50 copay for Medicare Dental Services. Other services such as oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, prosthodontics, and oral and maxillofacial surgery are covered with no copay, though coinsurance may apply. 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 H2486-007 (HMO) plan, which includes Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 5% coinsurance and authorization required, Prosthetics/Medical Supplies with a 5% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay up to $55, and lab services with no copay. Radiological Services include a copay up to $538 for diagnostic services, and 20% coinsurance (minimum) for therapeutic services, and no copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H2486-007 (HMO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but there is no cost information provided. However, the plan does not cover any of the sub-services associated with Cardiac Rehabilitation, including 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, but require prior authorization and a doctor's referral. For days 1-20, there is a $10 copay, for days 21-50, there is a $214 copay, and for days 51-100, there is no copay.
Other Services See details
Other Services includes acupuncture, with a $50 copay and a limit of 20 treatments per year, and meal benefits 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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