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Humana Gold Plus SNP-DE H4461-022 (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 H4461-022 (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 H4461-022 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Tennessee. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus SNP-DE H4461-022 (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 H4461-022 (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 H4461-022 (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 H4461-022 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.00. 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 $615.00 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:
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Drug Coverage
The Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay for one-month or three-month supplies filled at standard pharmacies or through preferred mail order. Standard mail order delivery for these generic tiers requires a copay, ranging from $10 to $20 for a one-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan charges a consistent 25% coinsurance across standard pharmacies and mail order options. This 25% coinsurance applies to both one-month and three-month supplies, though specialty tier medications are limited to a one-month supply.
Additional Benefits
The Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) plan provides comprehensive healthcare coverage with predictable cost-sharing for essential medical services. Inpatient hospital stays feature no coinsurance alongside a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay, while primary, specialist, and mental health visits require no copay and a 20% coinsurance. Emergency services are covered with a $115 copay, which is waived upon admission, and urgent care carries a 20% coinsurance with no copay. Members also enjoy extensive supplemental benefits designed to reduce out-of-pocket expenses. There is no copay and no coinsurance for home health services, routine preventive care, annual physical exams, and up to 100 one-way transportation trips per year. Furthermore, dental services are covered up to a $4,000 annual maximum, and prescription hearing aids and eligible eyewear are available with no copay and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) offers partially covered inpatient hospital services with no coinsurance, featuring a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay. While unlimited additional acute care days are covered with no copay, non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers outpatient hospital services with a $240 copay and 20% coinsurance, and ambulatory surgical center services with a $165 copay and 20% coinsurance. Outpatient substance abuse and blood services are covered with no copay and 20% coinsurance, with prior authorization required for most of these services.
Partial Hospitalization See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 100 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers emergency services with a $115 copay, which is waived if you are admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services are covered with a 20% coinsurance (up to $40) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers primary care, specialist, mental health, and therapy services with no copay and a 20% coinsurance. Chiropractic services are partially covered, as routine care is covered for up to 12 visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) plan, offering no copay and no coinsurance for covered benefits like annual physical exams and kidney disease education. However, several supplemental benefits are not covered, including health education, personal emergency response systems, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, disease management, telemonitoring, remote technologies, safety devices, and counseling.
Hearing Services See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) hearing services include Medicare-covered exams and hearing aid fittings with no copay and no coinsurance, plus one routine exam annually with no copay and 20% coinsurance. Prescription hearing aids (limited to two every three years) and unlimited OTC hearing aids are offered with no copay and no coinsurance, though prescription options are only partially covered as inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) with no deductibles, though prior authorization is required. Routine eye exams are covered once annually with no copay and a 20% coinsurance, and eligible eyewear has no copay and no coinsurance up to a $450 yearly limit, but other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $4,000 annual maximum. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers home infusion bundled services with prior authorization and step therapy requirements. Covered Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, with insulin requiring a $35 copay and other Part B drugs having no copay.
Dialysis Services See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with a 20% coinsurance and no copay. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers diagnostic and radiological services with prior authorization and a 20% coinsurance for all services. Under this plan, diagnostic procedures and lab services have no copay, outpatient x-rays require a $50 copay, and diagnostic radiological services carry a $200 copay.
Home Health Services See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) with no copay and require prior authorization. While some services are covered, specific sub-services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering 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 for admission, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP), excluding highly integrated services for dual eligibles. Covered benefits include acupuncture with no copay and 20% coinsurance, alongside over-the-counter items and chronic illness meals with no copay and no coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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