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Humana Gold Plus H4007-021 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4007-021 (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 H4007-021 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H4007-021 (HMO) is a HMO 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 H4007-021 (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 H4007-021 (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 H4007-021 (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 $48.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5000.00 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 H4007-021 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, some preferred generic drugs have no copay, while standard generic drugs have an $8 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. Please note that if you qualify for the low-income subsidy, your premium may be reduced.
Additional Benefits
The Humana Gold Plus H4007-021 (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $50 copay per admission, while outpatient services have copays that range from $0 to $50. Emergency services have a $75 copay, and primary care visits and many preventive services have no copay. The plan also covers services like hearing, vision, and dental with no copays for many services, and includes coverage for ambulance, home health, and medical equipment. Additional benefits include coverage for home infusion, dialysis, diagnostic services, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $50 copay per admission or stay. Additional Days for Inpatient Hospital-Acute are also covered, and have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $50, and observation services with a $50 copay. Ambulatory Surgical Center (ASC) Services have a $20 copay, while Outpatient Blood Services have no copay. Outpatient Substance Abuse Services are covered, with a maximum copay of $20 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H4007-021 (HMO) plan, with no copay required. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H4007-021 (HMO), including ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $75 copay, while air ambulance services have a 20% coinsurance, and transportation services have no copay. 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 H4007-021 (HMO) plan. Emergency Services have a $75 copay, while Urgently Needed Services have a $10 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $75 copay.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, and Other Health Care Professional visits have no copay. Occupational Therapy Services and Physical Therapy/Speech-Language Pathology Services have a $6 copay. Additional Telehealth Benefits have a copay between $0 and $10, and Opioid Treatment Program Services have a copay between $0 and $20. Podiatry Services are not covered, and Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, but the copays vary.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for a hearing aid with no copay for one visit per year. Prescription hearing aids have a maximum benefit of $500 per ear per year, and OTC hearing aids are covered with no copay, with a maximum benefit of $500 per ear per year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear has no copay, and contact lenses and eyeglasses (lenses and frames) are covered, with a combined maximum of $600 per year, while eyeglass lenses, eyeglass frames and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H4007-021 (HMO) plan covers Medicare Dental Services with no copay, and other dental services including oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), other preventive services, restorative services, endodontics, periodontics, prosthodontics (removable), implant services, prosthodontics (fixed), and oral and maxillofacial surgery, all with no coinsurance. Fluoride treatment, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. Coinsurance applies to Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with a minimum of 0% and a maximum of 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H4007-021 (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has no copay and no coinsurance, but requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay and no coinsurance, while 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 with a copay between $0 and $20, and Lab Services with no copay. Radiological Services are also covered, including Diagnostic Radiological Services with a copay up to $50, Therapeutic Radiological Services with no copay and up to 20% coinsurance, and Outpatient X-Ray Services with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H4007-021 (HMO) 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 by Humana Gold Plus H4007-021 (HMO), but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H4007-021 (HMO) plan, but the specific cost-sharing details are not provided in this snippet, and additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
The Humana Gold Plus H4007-021 (HMO) plan covers acupuncture with no copay, up to 20 treatments per year. Over-the-counter items and a meal benefit for chronic illness are also covered with no copay, while other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing, and others are not covered.
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