A non-government entity
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 2025, 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 4.5 out of 5 stars in 2025.
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 $40.00. 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 $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:
Sign up for Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP)
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 SNP-DE H4461-022 (HMO D-SNP) plan has a prescription drug deductible of $590. After the deductible is met, you will pay costs for your drugs based on the tier and pharmacy type. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, also known as LIS or "Extra help", and you will pay $40.00.
Additional Benefits
The Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays and coinsurance, and coverage for ambulance and emergency services. The plan also covers primary care, preventive services, hearing, vision, and dental services, often with no copay or a coinsurance of up to 20%. Additional benefits include coverage for home infusion bundled services, dialysis services, medical equipment, and diagnostic services. The plan also offers home health services and skilled nursing facility services, with varying cost-sharing. However, some services, such as cardiac rehabilitation and certain other services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under this plan. For Inpatient Hospital-Acute, there is a copay of $2185 per admission or stay, and additional days are covered with no copay; however, non-Medicare covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, there is a copay of $2036 per admission or stay, but additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $240 copay and 20% coinsurance, observation services with 20% coinsurance, and ambulatory surgical center services with a $200 copay and 20% coinsurance. Outpatient substance abuse services, including individual and group sessions, are covered with 20% coinsurance. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 100 trips per year. Transportation services to any other 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 SNP-DE H4461-022 (HMO D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have 20% coinsurance; Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits are covered with 20% coinsurance. Chiropractic Services, Podiatry Services, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with 20% coinsurance. Routine Chiropractic Care has no copay, and Routine Foot Care is covered with 20% coinsurance and no copay.
Preventive Services See details
The Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including wigs for hair loss related to chemotherapy, in-home support services, additional sessions of smoking and tobacco cessation counseling, and fitness benefits, are covered with no copay. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with no copay for all types, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered with a maximum amount of $60 every month.
Vision Services See details
The Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) plan covers vision services, including routine eye exams with no copay and 20% coinsurance, and eyewear. Eyewear includes contact lenses and eyeglasses (lenses and frames) with no copay and a combined maximum benefit of $450 every year, but does not cover eyeglass lenses, eyeglass frames, or upgrades.
Dental Services See details
The Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) plan covers dental services, including Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $4,000 per year. 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 fixed), and oral and maxillofacial surgery have no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) plan. Prior authorization is required, and you will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for Diabetic Supplies. Diabetic Therapeutic Shoes/Inserts have no copay, while DME and Diabetic Supplies 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. Diagnostic procedures/tests have a coinsurance of at most 20%, and lab services have a $0 copay and a coinsurance of at most 20%. Diagnostic radiological services have a copay of at most $300 and a coinsurance of at most 20%, while therapeutic radiological services and outpatient X-ray services have a coinsurance of at most 20%, with outpatient X-ray services also having a $50 copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) 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 not covered by the Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services includes acupuncture with a 20% coinsurance, and a meal benefit with no copay. Over-the-counter items are covered with a maximum plan benefit coverage amount of $60.00 every month. Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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