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Humana Gold Plus H4007-029 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4007-029 (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 H4007-029 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H4007-029 (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 H4007-029 (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 H4007-029 (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 H4007-029 (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 $143.00. 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 H4007-029 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy used. For example, preferred generic drugs and specialty tier drugs have no copay at standard, preferred, and mail-order pharmacies. Standard generic drugs have a $15 copay at preferred pharmacies, and a $16 copay at standard mail-order pharmacies.
Additional Benefits
The Humana Gold Plus H4007-029 (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $50 copay, while outpatient services have copays ranging from $0 to $50. Emergency services have a $75 copay, and primary care, preventive services, hearing, vision, and dental services generally have no copay. This plan also includes benefits such as ambulance services with a $50 copay for ground transport and 20% coinsurance for air ambulance, along with home health services and medical equipment with no copay. Diagnostic and radiological services have copays and coinsurance, and other services like acupuncture and over-the-counter items have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $50 copay per admission or stay. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, as are additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $50, observation services have a $50 copay, ASC services have a $20 copay, individual and group outpatient substance abuse sessions 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 H4007-029 (HMO) plan, with no copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H4007-029 (HMO). Ground ambulance services have a $50 copay, while air ambulance services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H4007-029 (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. There is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus H4007-029 (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, physician specialist services, individual and group sessions for mental health and psychiatric services, and other health care professional services have no copay, while occupational therapy services, physical therapy and speech-language pathology services have a $6 copay, and additional telehealth benefits have a copay between $0 and $10.
Preventive Services See details
Preventive Services are covered by the Humana Gold Plus H4007-029 (HMO) plan, including an annual physical exam with no copay, and additional preventive services are covered. Fitness benefits, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following the Welcome Visit have no copay.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay, with one exam covered per year. Fitting/evaluation for hearing aids have no copay, with one fitting/evaluation covered per year. Prescription hearing aids have a maximum benefit of $250 per ear every year, with no copay for all types. OTC hearing aids have no copay, with a maximum benefit of $250 per ear every year.
Vision Services See details
The Humana Gold Plus H4007-029 (HMO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and there is a $400 combined maximum plan benefit per year for eyewear.
Dental Services See details
The Humana Gold Plus H4007-029 (HMO) plan covers Medicare Dental Services with no copay, as well as Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery with no coinsurance. Fluoride Treatment, Maxillofacial Prosthetics, and Orthodontics are not covered. Orthodontic Services have a maximum benefit of $1,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H4007-029 (HMO) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered under this plan, with no coinsurance. Durable Medical Equipment (DME) has no copay, but authorization is required, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no coinsurance, and no copay. Diabetic Equipment is covered, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $20, lab services with no copay, and diagnostic radiological services with a copay up to $50. Therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H4007-029 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Humana Gold Plus H4007-029 (HMO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H4007-029 (HMO) plan, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required for this benefit, and more information on the copay is available in the plan details.
Other Services See details
Other Services includes coverage for acupuncture, over-the-counter items, and a meal benefit. Acupuncture has no copay, while over-the-counter items and the meal benefit also have no copay.
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