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Humana Gold Plus SNP-DE H4141-003 (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 H4141-003 (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 H4141-003 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Greater Georgia Area. 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 H4141-003 (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 H4141-003 (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 H4141-003 (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 H4141-003 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $9350.00 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 H4141-003 (HMO D-SNP) plan has a deductible of $590.00. If you qualify for the low-income subsidy, you will pay $27.30 per month for Part D. During the initial coverage phase, after you pay your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. Once your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) plan provides comprehensive coverage, including inpatient hospital stays with a copay, and outpatient services with 20% coinsurance. Emergency services have a $110 copay, and you'll pay no copay for primary care, and vision services like eye exams and eyewear. Dental services are covered with 20% coinsurance, and other dental services have a $2,000 annual maximum. This plan offers additional benefits such as hearing exams with coinsurance, and prescription hearing aids with no copay. Medical equipment, home health services, and skilled nursing facility services are also covered. Additional benefits include acupuncture, an over-the-counter (OTC) item benefit, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $2185 copay per admission or stay, and for Inpatient Hospital Psychiatric, there is a $2036 copay per admission or stay. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance, and Outpatient Substance Abuse Services with a 20% coinsurance for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground and air ambulance services each have a copay of $315, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services include coverage for emergency services, urgently needed services, and worldwide emergency services. Emergency services have a $110 copay and no coinsurance, while urgently needed services have a 20% coinsurance and no copay. Worldwide emergency services have a $110 copay for worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation.
Primary Care See details
The Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) plan covers primary care physician services, chiropractic services with no copay and 20% coinsurance, 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 with no copay and 20% coinsurance, and opioid treatment program services; however, podiatry services are not covered, and routine chiropractic care is not covered. Individual and group sessions for mental health and psychiatric services, the coinsurance is 20%.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services including fitness benefits with no copay, plus kidney disease education services, and other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit, all with no copay. Health education, in-home safety assessment, personal emergency response system, 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 benefit, 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, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% and a copay that varies. Prescription hearing aids are covered with no copay for Prescription Hearing Aids (all types). OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, and other dental services with a $2,000 annual maximum. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with no copay, and fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
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 is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%, and there is no copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) plan, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Diabetic Supplies have a 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. For diagnostic procedures/tests, you may pay up to 20% coinsurance, and for lab services, you'll pay no copay and up to 20% coinsurance. For diagnostic radiological services, you may pay a copay of $200-$325 and up to 20% coinsurance. For therapeutic radiological services, you may pay up to 20% coinsurance, and for outpatient X-ray services, you'll pay a $50 copay and up to 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but none of the sub-services (Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, and Additional Cardiac Rehabilitation Services) are covered. There is coinsurance for some services; however, the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) plan, but prior authorization is required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.00. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) plan offers acupuncture with 20% coinsurance, over-the-counter (OTC) items with a maximum benefit of $1440 per year, and a meal benefit with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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