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Humana Gold Plus SNP-DE H4007-031 (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 H4007-031 (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 H4007-031 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H4007-031 (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 H4007-031 (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 H4007-031 (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 H4007-031 (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 H4007-031 (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 $120.00. 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 H4007-031 (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, you will have no copay for your prescriptions. During the initial coverage phase, you will pay the costs for your drugs until your total drug costs reach $2000. Once you reach this amount, you will enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) plan offers a wide range of benefits with no copay, including inpatient and outpatient hospital services, ambulance services, emergency services, primary care, preventive services, hearing exams, vision exams, and dental services. Many services, such as home health and dialysis, also have no copay. The plan covers hearing aids up to $1000 per year, and provides coverage for prescription hearing aids and OTC hearing aids, with no copay. It covers durable medical equipment with a 10% coinsurance. The plan also covers acupuncture and over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with no copay for a Medicare-covered stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services have no copay. Outpatient substance abuse services, including individual and group sessions, have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan with no copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) plan. Ground and Air Ambulance Services have no copay and no coinsurance, but 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 this plan. There is no copay or coinsurance for Emergency Services, and Urgently Needed Services has no copay and no coinsurance. Worldwide Emergency Services has a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
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 with no copay for most services. Routine Chiropractic Care is covered for 12 visits per year with no copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services with a copay. Additional preventive services include additional sessions of smoking and tobacco cessation counseling, fitness benefit, and home and bathroom safety devices and modifications.
Hearing Services See details
The Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) plan covers hearing exams with no copay, as well as routine hearing exams and fitting/evaluation for hearing aids, each with no copay. Prescription Hearing Aids are covered, and the plan covers up to $1000 per year. OTC hearing aids are covered with no copay, up to $1000 per ear every year.
Vision Services See details
The Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) plan covers eye exams and eyewear. Routine eye exams and eyewear (lenses and frames) have no copay, while contact lenses have no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no coinsurance; fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum plan benefit of $1,000 per year, and Medicare dental services require prior authorization and a doctor referral, with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs and Medicare Part B Chemotherapy/Radiation Drugs have no copay, and Other Medicare Part B Drugs have a copay of $0.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
The Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) plan covers Durable Medical Equipment (DME) with a 10% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 10% coinsurance, and Medical Supplies have no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) 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 not covered by the Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) plan. 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 and non-Medicare-covered stays are not covered. Prior authorization is required, and copay information is available in the plan details.
Other Services See details
The Humana Gold Plus SNP-DE H4007-031 (HMO D-SNP) plan covers acupuncture with no copay, and Over-the-Counter (OTC) items with no copay. The plan also covers 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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