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Humana Gold Plus SNP-DE H4007-027 (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 H4007-027 (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 H4007-027 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H4007-027 (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 H4007-027 (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 H4007-027 (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 H4007-027 (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 H4007-027 (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 $23.00. 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 $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 H4007-027 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you will pay $0 for Part D drugs. Once 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 H4007-027 (HMO D-SNP) plan offers comprehensive coverage with no copays for many services, including inpatient and outpatient hospital services, primary care, preventive services, hearing and vision exams, and dental services. The plan also provides coverage for ambulance and transportation services, emergency services, and home health services, all with no copays. This plan also offers additional benefits, such as coverage for over-the-counter items and acupuncture.
Inpatient Hospital See details
The Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP) plan covers Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services with no copay, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered under this plan. There is no copay for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. There is also no copay for individual and group sessions for outpatient substance abuse.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, with a $0 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and Air Ambulance Services have no copay and no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year, with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP) plan. Urgently Needed Services has no copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation also have no copay. All other services have no coinsurance.
Primary Care See details
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 are covered under this plan. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Chiropractic Services do not cover routine care, while Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services and additional preventive services, as well as annual physical exams, with no copay. Additional services like Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and more are not covered.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids (all types) are covered, with a maximum benefit of $1000 per ear every year and OTC hearing aids are covered with no copay and a maximum benefit of $1000 per ear every year. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP) plan covers vision services, including eye exams and eyewear, with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, endodontics, periodontics, prosthodontics (removable, fixed), implant services, and oral and maxillofacial surgery are covered with no coinsurance, while fluoride treatment, maxillofacial prosthetics, and orthodontics are not covered. Preventive services have visit limits and other services may require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs and Medicare Part B Chemotherapy/Radiation Drugs have no copay. Other Medicare Part B Drugs have a copay of $0.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered by Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP). DME has a 10% coinsurance, and Prosthetic Devices have a 10% to 10% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services, are covered. Diagnostic Procedures/Tests and Outpatient X-Ray Services have no copay, while Lab Services have a $0 copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a maximum copay of $0.
Home Health Services See details
Home Health Services are covered 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 specify the cost sharing details. However, 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 are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. The plan does not cover additional days beyond Medicare-covered SNF stays, and it also does not cover non-Medicare-covered SNF stays.
Other Services See details
The Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP) plan covers acupuncture with no copay for up to 20 treatments per year, and also covers over-the-counter (OTC) items with no copay up to $2280.00 per year, including Nicotine Replacement Therapy and Naloxone. The plan's meal benefit is covered with no copay, but requires prior authorization. Some other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
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