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Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Puerto Rico Island Wide. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP).
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 SNP-DE H4007-016 (HMO D-SNP), 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 $68.50. 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 $3400.00 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 SNP-DE H4007-016 (HMO D-SNP) plan has a $590 deductible for prescription drugs. Once the deductible is met, you will pay the costs for your drugs as outlined in the plan's formulary until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your Part D costs will be $0. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) plan offers comprehensive coverage with no copays for many services. This includes inpatient and outpatient hospital services, primary care, preventive services, hearing and vision exams, dental services, home health, and medical equipment. Emergency services and ambulance services also have no copay, and the plan provides coverage for prescription hearing aids up to $1000 per ear annually.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization, and have no copay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute are covered with no copay, while 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, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by this plan. Outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services have no copay. Outpatient substance abuse services have no copay for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization and no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with no coinsurance and no copay for ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year, while 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 this plan. There is no copay or coinsurance for Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation. Urgently Needed Services has a copay of $0, and no coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay. Routine chiropractic care has a $0 copay for up to 12 visits per year, while podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services that require prior authorization. Some additional services include additional sessions of smoking and tobacco cessation counseling, fitness benefit, and home and bathroom safety devices and modifications. Some services, such as health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are covered with no copay.
Hearing Services See details
Hearing exams are covered with no copay. Routine hearing exams and fitting/evaluation for hearing aids are also covered with no copay, and you are allowed one routine hearing exam and one fitting/evaluation per year. Prescription hearing aids are covered, with a plan-specified amount of $1000 per ear every year, and OTC hearing aids are covered with no copay, up to $1000 per ear every year. However, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and the plan covers contact lenses and eyeglasses (lenses and frames) with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with no copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no coinsurance. Orthodontic Services are covered up to a maximum of $2000 per year, and restorative services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered with no coinsurance. Fluoride treatment, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. This includes Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) plan. There is no copay for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and no coinsurance, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay and no coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests and Outpatient X-Ray Services have no copay, while Lab Services, Diagnostic Radiological Services, and Therapeutic Radiological Services have a $0 copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) plan 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 plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare coverage and non-Medicare covered stays are not covered. Prior authorization is required, and there is a copay.
Other Services See details
The Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) plan covers acupuncture with no copay, and covers over-the-counter items and meal benefits with no copay; however, some other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services and Private Duty Nursing Services are not covered. Acupuncture has a limit of 20 treatments per year.
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