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Humana Gold Plus H4141-017 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4141-017 (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 H4141-017 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H4141-017 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Georgia. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H4141-017 (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 H4141-017 (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 H4141-017 (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 $1.00. 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 $350.00 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 H4141-017 (HMO) plan has a $350 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, Tier 1 preferred generic drugs have a $5 copay at standard and mail order pharmacies, while standard generic drugs (Tier 2) have a $47 copay. Once your total yearly drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus H4141-017 (HMO) plan offers a wide array of benefits, with a focus on outpatient services and preventive care. Many services have no copay, including routine eye exams, outpatient blood services, and oral exams. The plan also provides coverage for inpatient hospital stays, with copays varying by day, and includes emergency services with a $110 copay. This plan covers a range of services with copays, such as specialist visits, hearing exams, and ambulance services. It also includes benefits like home health services with no copay, and offers additional benefits such as an over-the-counter allowance and a meal benefit. However, some services, like additional hours of care, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $298 copay for days 1-8, and no copay for days 9-90, with no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $587 copay for days 1-3, and no copay for days 4-90, with no coinsurance.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $395, observation services with a $298 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay between $45 and $100 for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H4141-017 (HMO) plan, and requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services each have a $315 copay, with no 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 H4141-017 (HMO) plan. Emergency Services have a $110 copay and no coinsurance, Urgently Needed Services have a $45 copay and no coinsurance, and Worldwide Emergency Services have a $110 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Gold Plus H4141-017 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, and physician specialist services with a $10 copay. Mental health specialty services and psychiatric services include individual and group sessions with a $45 copay, and physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits range from no copay to a $45 copay, and opioid treatment program services have a copay between $45 and $100.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Other services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
The Humana Gold Plus H4141-017 (HMO) plan covers hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $499 and $799 for all types of prescription hearing aids, but not for inner, outer, or over-the-ear hearing aids. OTC hearing aids are covered with a maximum benefit of $40 every three months.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $10, and routine eye exams have no copay. Eyewear has no copay, and the plan offers a combined maximum of $150 per year for all eyewear.
Dental Services See details
The Humana Gold Plus H4141-017 (HMO) plan covers dental services, including oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, other preventive dental services with no copay, restorative services with no copay, adjunctive general services with no copay, endodontics with no copay, periodontics with no copay, prosthodontics (removable) with no copay, and oral and maxillofacial surgery with no copay. The plan does not cover fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), or orthodontics.
Home Infusion bundled Services See details
The Humana Gold Plus H4141-017 (HMO) plan covers Home Infusion bundled Services with prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H4141-017 (HMO) plan and require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Humana Gold Plus H4141-017 (HMO). Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization. Prosthetics/Medical Supplies and Prosthetic Devices also have a 20% coinsurance. Diabetic Supplies have no copay and a 10% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The Humana Gold Plus H4141-017 (HMO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $120, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $325, Therapeutic Radiological Services have a copay up to $10 and coinsurance up to 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H4141-017 (HMO) 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 covered, though the plan does not specify the cost-sharing details. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H4141-017 (HMO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100, and additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H4141-017 (HMO) plan covers acupuncture with a $10 copay and a limit of 20 treatments per year. This plan also offers an Over-the-Counter (OTC) benefit with a maximum of $40 every three months, and covers a meal benefit with no copay. Other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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