A non-government entity
Humana Gold Plus Giveback H4141-022 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H4141-022 (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 Giveback H4141-022 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H4141-022 (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 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus Giveback H4141-022 (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 Giveback H4141-022 (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 Giveback H4141-022 (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 $135.00. 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 $450.00 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 $9250.00 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:
Sign up for Humana Gold Plus Giveback H4141-022 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus Giveback H4141-022 (HMO) prescription drug plan features an annual drug deductible of $450. For Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Standard mail-order deliveries for these generic tiers require a copay ranging from $10 to $20 for a 1-month supply. Tier 3 (Preferred Brand) medications cost a $47 copay for a 1-month supply, with a reduced 3-month copay of $131 when filled through preferred mail order. More expensive medications require coinsurance instead of copays, with Tier 4 (Non-Preferred) drugs requiring 43% coinsurance and Tier 5 (Specialty) drugs requiring 27% coinsurance. This Medicare Advantage plan provides cost-effective options for generic prescriptions while utilizing coinsurance for higher-tier medications.
Additional Benefits
The Humana Gold Plus Giveback H4141-022 (HMO) offers comprehensive medical coverage with clear, predictable cost-sharing. Members enjoy no copay for primary care visits, preventive screenings, and home health services, while specialist visits require a $40 copay. Inpatient hospital stays have a $375 daily copay for the first seven days and no copay thereafter, while outpatient hospital services feature no coinsurance and a copay ranging from $0 to $450. This plan also includes key supplemental benefits, such as routine dental and vision exams with no copay, plus a $150 annual allowance for contacts or eyeglasses. Diagnostic lab work and X-rays are covered with no copay, while durable medical equipment and diabetic supplies carry a 10% to 20% coinsurance with no copay. Emergency services are available for a $115 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
Humana Gold Plus Giveback H4141-022 (HMO) covers inpatient acute hospital stays with no coinsurance and a $375 daily copay for days 1 to 7, with no copay for days 8 and beyond. Inpatient psychiatric care is also covered with no coinsurance, featuring a $375 daily copay for days 1 to 5 and no copay for days 6 to 90, though prior authorization is required and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H4141-022 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus Giveback H4141-022 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Humana Gold Plus Giveback H4141-022 (HMO) with a $335 copay and no coinsurance for ground and air transport, though prior authorization is required. While some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus Giveback H4141-022 (HMO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Giveback H4141-022 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Additional covered services include physical and occupational therapy for a $25 copay, psychiatric and mental health services for a $35 copay, and telehealth for a $0 to $40 copay, all with no coinsurance. Podiatry is not covered, and chiropractic care is only partially covered as routine chiropractic services are excluded.
Preventive Services See details
Preventive services are partially covered under the Humana Gold Plus Giveback H4141-022 (HMO) plan, featuring no copay and no coinsurance for annual physical exams, kidney disease education, and select screenings. Uncovered sub-services include health education, fitness benefits, PERS, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Humana Gold Plus Giveback H4141-022 (HMO) partially covers hearing services, offering Medicare-covered exams for a $40 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Covered prescription hearing aids require a copay of $699 to $999 with no coinsurance for up to two aids per year, but OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus Giveback H4141-022 (HMO) offers partially covered vision services with no copay and no coinsurance, though prior authorization is required. Covered benefits include one routine eye exam and one pair of contact lenses or eyeglasses (lenses and frames) per year up to a $150 maximum, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Giveback H4141-022 (HMO) dental services are partially covered, offering Medicare-covered dental care for a $40 copay and no coinsurance, and preventive services like exams and cleanings with no copay and no coinsurance. While many restorative and surgical dental services are covered, this plan does not cover fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H4141-022 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs have a 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus Giveback H4141-022 (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment covered by Humana Gold Plus Giveback H4141-022 (HMO) includes durable medical equipment (DME) at a 19% coinsurance with no copay, and prosthetics and medical supplies at a 20% coinsurance with no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus Giveback H4141-022 (HMO) covers diagnostic and radiological services under prior authorization, offering diagnostic lab services and outpatient X-rays with no copay. Diagnostic procedures and tests have no coinsurance and copays ranging from $0 to $120, while therapeutic radiological services require a minimum 20% coinsurance and a $40 copay.
Home Health Services See details
Humana Gold Plus Giveback H4141-022 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Humana Gold Plus Giveback H4141-022 (HMO) plan. This exclusion applies to all related sub-services, including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus Giveback H4141-022 (HMO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus Giveback H4141-022 (HMO) partially covers other services, offering acupuncture for a $40.00 copay and no coinsurance for up to 20 treatments per year, and a meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved