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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 $3.00. 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 will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy, and 38% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H4141-017 (HMO) plan offers a wide array of benefits, including coverage for inpatient and outpatient services with varying copays. It also covers a range of primary care services, preventive services with no copay for many services, and offers dental, vision, and hearing benefits. You will also have coverage for ambulance, emergency, and home health services. This plan also provides coverage for home infusion services, dialysis, and medical equipment, with associated copays or coinsurance. You can also expect coverage for various diagnostic and radiological services, and skilled nursing facility (SNF) services. However, certain services such as cardiac rehabilitation, podiatry, and specific dental procedures are not covered.
Inpatient Hospital See details
Inpatient hospital services are covered, including acute and psychiatric care. For acute care, you'll pay a $384 copay for days 1-6, and no copay for days 7-90, with additional days 91-999 covered with no copay; non-Medicare-covered stays and upgrades are not covered. For inpatient psychiatric care, there is a $384 copay for days 1-5, and no copay for days 6-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $450, observation services with a $384 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $45 and $100 for individual and group sessions, and outpatient blood services with no copay. Outpatient services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H4141-017 (HMO) plan, with an $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H4141-017 (HMO) plan. Both ground and air ambulance services have a $315 copay with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed and worldwide emergency services, are covered. For emergency services, the copay is $110, while urgently needed services have a $45 copay, and there is no coinsurance for either. Worldwide emergency services also have a $110 copay for worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a $5 copay, Chiropractic Services with a $15 copay (routine care not covered), Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $20 copay, Mental Health Specialty Services with a $45 copay for individual and group sessions, Other Health Care Professional services with a copay between $5 and $20, Psychiatric Services with a $45 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits with a copay between $0 and $45, and Opioid Treatment Program Services with a copay between $45 and $100. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, 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. However, health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), 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 benefits, 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
The Humana Gold Plus H4141-017 (HMO) plan covers hearing exams for a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899, but prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a copay of $0-$20, while routine eye exams have no copay. Eyewear has no copay, but there is a combined maximum benefit of $250 per year for contact lenses and eyeglasses.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $20 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services with 30%-40% coinsurance, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable) with 30% coinsurance, Prosthodontics (fixed) with 30%-40% coinsurance, and Oral and Maxillofacial Surgery with no copay; however, Fluoride Treatment, Maxillofacial Prosthetics, Implants Services, and Orthodontics are not covered. The plan has an annual maximum benefit of $1500.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, Medicare Part B Chemotherapy/Radiation Drugs with coinsurance between 0% and 20%, and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H4141-017 (HMO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and requires prior authorization, while Prosthetic Devices have a 20% coinsurance. Diabetic Supplies have a 10% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $120, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $325, Therapeutic Radiological Services have a copay of at most $20 and a coinsurance of at least 20%, and Outpatient X-Ray Services have a $5 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, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Humana Gold Plus H4141-017 (HMO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H4141-017 (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. 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 $20 copay, and a meal benefit with no copay. Other services like over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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