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Humana Gold Plus H4007-024 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4007-024 (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 H4007-024 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H4007-024 (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 H4007-024 (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 H4007-024 (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 H4007-024 (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 $2.50. 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 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 H4007-024 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have no copay at standard and mail-order pharmacies, while standard generic drugs have a $10-$11 copay. The plan also has a catastrophic coverage phase where you pay nothing for covered drugs after your yearly out-of-pocket drug costs reach $2000.
Additional Benefits
The Humana Gold Plus H4007-024 (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. Emergency, urgent, and primary care services are covered, and many have no copay. Preventive services, such as annual physical exams, and some hearing, vision, and dental services also have no copay. Additional benefits include ambulance, home health, and home infusion services, with copays or coinsurance applying in some cases. Diagnostic and radiological services, along with medical equipment, are covered with a mix of copays and coinsurance. The plan also includes coverage for other services such as acupuncture, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage under the Humana Gold Plus H4007-024 (HMO) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization, with a $75 copay per admission or stay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, 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 (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services are covered. Outpatient Hospital Services have a copay between $0 and $75, Observation Services have a $75 copay, Ambulatory Surgical Center (ASC) Services have a $20 copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay between $0 and $20, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H4007-024 (HMO) plan, with no copay required. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $75 copay, and air ambulance services with 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year. 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 by the Humana Gold Plus H4007-024 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $75 copay, Urgently Needed Services have a $10 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $75 copay.
Primary Care See details
The Humana Gold Plus H4007-024 (HMO) 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. Primary care physician services, chiropractic services (including routine care), physician specialist services, mental health specialty services (individual and group sessions), other health care professional services, psychiatric services (individual and group sessions), and additional telehealth benefits have no copay. Occupational therapy services and physical therapy/speech-language pathology services have a $6 copay. Opioid Treatment Program Services have a copay between $0-$20. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, as well as additional preventive services, kidney disease education services, and other preventive services. Health education, in-home safety assessments, personal emergency response systems, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered. Glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have no copay.
Hearing Services See details
Humana Gold Plus H4007-024 (HMO) covers hearing exams with no copay, and also covers routine hearing exams and fitting/evaluation for hearing aids with no copay. The plan also covers prescription hearing aids, with a maximum benefit of $500 per ear every year, and OTC hearing aids with no copay and a maximum benefit of $500 per ear every year. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear, with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H4007-024 (HMO) plan covers Medicare Dental Services with no copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no coinsurance. Fluoride treatment and orthodontics are not covered, while a $2,500 maximum benefit applies to orthodontic services.
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, and the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H4007-024 (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Humana Gold Plus H4007-024 (HMO). Durable Medical Equipment (DME) has no coinsurance and a copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no coinsurance and a $0 copay. Diabetic Equipment has a copay for Medicare-covered Diabetic Supplies and Diabetic Therapeutic Shoes or Inserts, and also has a $0 copay for both supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $20, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $75, Therapeutic Radiological Services with no copay and a coinsurance up to 20%, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H4007-024 (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 H4007-024 (HMO), but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays. Prior authorization is required for SNF services, and more information about the copay is available in the plan documents.
Other Services See details
The Humana Gold Plus H4007-024 (HMO) plan covers acupuncture with no copay, up to 20 treatments per year, as well as over-the-counter items and a meal benefit with no copay. However, this plan does not cover 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.
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