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Humana Gold Plus H4461-025 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-025 (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 H4461-025 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-025 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in West Tennessee. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-025 (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 H4461-025 (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 H4461-025 (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 $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 $4700.00 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 H4461-025 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies, or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs cost a $47 copay for a 1-month supply, or $131 for a 3-month supply through preferred mail order. For higher-tier medications, Tier 4 non-preferred drugs require a 48% coinsurance, and Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus H4461-025 (HMO) plan offers robust medical coverage featuring no copay for primary care visits, home health services, and routine preventive care. Specialist visits require a low $15 copay, while inpatient hospital stays carry a $295 daily copay for the first six days. Emergency room visits have a $130 copay, which is waived if you are admitted, and urgent care is available for a $50 copay. This plan also includes generous dental, vision, and hearing benefits, highlighted by a dental allowance of up to $3,000 and routine eye exams and eyewear with no copay up to a $450 annual limit. Routine hearing exams and over-the-counter hearing aids are covered with no copay, while prescription hearing aids require copays between $199 and $499. Additionally, most diagnostic lab services, outpatient X-rays, and home infusion services are provided with no copay.
Inpatient Hospital See details
Humana Gold Plus H4461-025 (HMO) covers inpatient hospital services with no coinsurance, requiring a $295 daily copay for days 1 through 6 and no copay for subsequent covered days. This benefit is partially covered, as room upgrades, non-Medicare-covered stays, and psychiatric hospital stays beyond 90 days are not covered.
Outpatient Services See details
Humana Gold Plus H4461-025 (HMO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $250, observation services have a $295 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Gold Plus H4461-025 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H4461-025 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services are not covered by the plan, meaning transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Gold Plus H4461-025 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H4461-025 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Physical, occupational, and mental health therapies have copays ranging from $20 to $35 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H4461-025 (HMO) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and select screenings. However, several additional services are not covered, including health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus H4461-025 (HMO) hearing services are covered, featuring a $15 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with a $199 to $499 copay and no coinsurance for up to two aids per year, though inner ear, outer ear, and over-the-ear models are not covered. Over-the-counter (OTC) hearing aids are fully covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H4461-025 (HMO), offering routine eye exams, contact lenses, and eyeglasses with no copay, no coinsurance, and a $450 yearly limit. Other eye exams require a copay of $0 to $15 and no coinsurance, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4461-025 (HMO) dental services are partially covered, offering up to a $3,000 annual maximum benefit with no copay and no coinsurance for most preventive and comprehensive services, while Medicare-covered dental services require a $15 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus H4461-025 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and other drugs, require coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs have a $35 copay.
Dialysis Services See details
Humana Gold Plus H4461-025 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Humana Gold Plus H4461-025 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and 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 and coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-025 (HMO) covers diagnostic and radiological services with prior authorization required, offering no copay and no coinsurance for diagnostic lab and radiological services. Diagnostic procedures have a copay of $0 to $100 with no coinsurance, outpatient X-rays have no copay, and therapeutic radiological services require a minimum $15.00 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus H4461-025 (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H4461-025 (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice. These services require prior authorization and feature no coinsurance, but they carry a $15 copay.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-025 (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H4461-025 (HMO) offers partially covered Other Services, featuring acupuncture for a $15.00 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits for no copay and no coinsurance. Other miscellaneous services and highly integrated dual eligible SNP benefits are not covered under this plan.
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