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Humana Gold Plus H4007-025 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4007-025 (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 H4007-025 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H4007-025 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Municipalities. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H4007-025 (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 H4007-025 (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 H4007-025 (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 $113.00. 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 H4007-025 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays and coinsurance amounts depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at standard and mail-order pharmacies, while standard generic drugs have a $7.00 copay at preferred pharmacies and a $11.00 copay at standard mail-order pharmacies. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H4007-025 (HMO) plan offers a range of benefits with varying costs. Many services have no copay, including primary care, preventive services, hearing exams, vision exams and eyewear, and dental services. However, some services have copays, such as inpatient hospital stays at $75 per admission, emergency services at $75, and outpatient services ranging from $0 to $75. This plan also covers services like ambulance, diagnostic and radiological services, and home health services. The plan includes coverage for hearing aids, with a $500 maximum benefit per ear per year, and a $400 per year maximum for all eyewear. Dental services include a $2000 maximum benefit per year for orthodontic services.
Inpatient Hospital See details
Inpatient Hospital benefits for the Humana Gold Plus H4007-025 (HMO) plan include a $75 copay per admission or stay for Medicare-covered inpatient stays, with additional days for Inpatient Hospital-Acute covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $75, observation services with a $75 copay, ambulatory surgical center services with a $20 copay, outpatient substance abuse services with a copay between $0 and $20 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H4007-025 (HMO) plan with no copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground Ambulance Services have a $75 copay, while Air Ambulance Services have a 20% coinsurance. 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 H4007-025 (HMO) plan. Emergency Services have a $75 copay, Urgently Needed Services have a $10 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $75 copay.
Primary Care See details
The Humana Gold Plus H4007-025 (HMO) plan offers primary care physician services, chiropractic services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, additional telehealth benefits, and opioid treatment program services with no copay. Occupational therapy services and physical therapy/speech-language pathology services have a $6 copay. Routine chiropractic care has a $0 copay for up to 12 visits per year. Podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services with a copay. This plan also covers fitness benefits, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay. Some services, such as health education, in-home safety assessments, and counseling services, are not covered.
Hearing Services See details
Hearing Services include hearing exams and OTC hearing aids with no copay, and prescription hearing aids with a $500 maximum benefit per ear per year. Prescription hearing aids - inner ear, outer ear and over the ear are not covered.
Vision Services See details
The Humana Gold Plus H4007-025 (HMO) plan covers vision services, including routine eye exams and eyewear. Eye exams and eyewear have no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered. There is a combined maximum of $400 per year for all eyewear.
Dental Services See details
Humana Gold Plus H4007-025 (HMO) covers dental services, including oral exams, dental x-rays, other diagnostic services, cleanings, restorative services, endodontics, periodontics, removable prosthodontics, implant services, fixed prosthodontics, and oral and maxillofacial surgery with no coinsurance. Fluoride treatments, maxillofacial prosthetics, and orthodontics are not covered, and other preventive services have no coinsurance. Orthodontic services have a maximum benefit of $2000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H4007-025 (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H4007-025 (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus H4007-025 (HMO) plan. Durable Medical 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; and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with copays ranging from $0 to $20, and lab services with no copay. Outpatient X-Ray Services have no copay, while Diagnostic Radiological Services have a copay up to $75, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H4007-025 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered, 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 for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and more information on the copay is available in the plan details.
Other Services See details
The Humana Gold Plus H4007-025 (HMO) plan covers acupuncture with no copay and over-the-counter items with no copay, up to $15 per month, and a meal benefit with no copay. However, the 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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