A non-government entity
Humana Gold Plus H4461-035 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-035 (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 H4461-035 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-035 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in East Tennessee. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-035 (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 H4461-035 (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 H4461-035 (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 $2.00. 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 $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 $3600.00 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 H4461-035 (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 H4461-035 (HMO) prescription drug plan features an annual drug deductible of $590. For Tier 1 preferred generics, you will pay no copay at standard pharmacies and through preferred mail order for both 1-month and 3-month supplies. Tier 2 generic drugs cost as little as a $5 copay for a 1-month supply, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail-order options. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring a 47% coinsurance and Tier 5 specialty drugs requiring a 26% coinsurance. This structure helps you manage medication costs effectively by choosing preferred mail order and standard pharmacy options.
Additional Benefits
The Humana Gold Plus H4461-035 (HMO) plan offers comprehensive healthcare coverage with no copay for primary care doctor visits and covered preventive services. For hospital care, inpatient stays require a $275 daily copay for days one through five and no copay for days six through ninety. Emergency services are available with a $150 copay, which is waived if you are admitted, while specialist visits carry a copay of $20 to $35. Members also receive valuable supplemental benefits, including dental coverage with a $3,000 annual maximum and no copay for most diagnostic and preventive care. Vision and hearing benefits feature routine exams with no copay, a $300 allowance for eyewear, and covered over-the-counter hearing aids. Additionally, the plan covers home health services with no copay and offers up to 36 free one-way transportation trips per year to approved locations.
Inpatient Hospital See details
Humana Gold Plus H4461-035 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, subject to prior authorization. For both stays, you pay a $275 daily copay for days 1 through 5 and no copay for days 6 through 90, with unlimited additional acute days covered at no copay. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H4461-035 (HMO) outpatient services are covered with no coinsurance, though prior authorization is required for most treatments. There is no copay for ambulatory surgical center and outpatient blood services, while outpatient hospital visits range from a $0 to $225 copay, observation services cost a $275 copay per stay, and substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Humana Gold Plus H4461-035 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H4461-035 (HMO) 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 36 one-way trips per year to plan-approved locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Humana Gold Plus H4461-035 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are available with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H4461-035 (HMO) features primary care physician services with no copay and no coinsurance, while specialists, physical therapy, and mental health services are covered with copays ranging from $20 to $35 and no coinsurance. Chiropractic and podiatry services are not covered, though telehealth benefits are available with copays from $0 to $65 and no coinsurance.
Preventive Services See details
Humana Gold Plus H4461-035 (HMO) preventive services are partially covered with no copays and no coinsurance for covered benefits like annual physical exams, kidney disease education, glaucoma screenings, diabetes training, in-home support, and memory fitness. Sub-services that are not covered under this benefit include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus H4461-035 (HMO) covers Medicare-covered hearing exams for a $30 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with a $399 to $699 copay and no coinsurance, though inner ear, outer ear, and over the ear hearing aids are not covered, while over-the-counter hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H4461-035 (HMO) partially covers vision services with no deductibles, with uncovered sub-services including other eye exam services, eyeglass lenses, eyeglass frames, and upgrades. Covered eye exams have a copay of $0 to $30 and no coinsurance, while covered eyewear features no copay, no coinsurance, and a $300 annual limit for one pair of contact lenses or eyeglasses per year.
Dental Services See details
Humana Gold Plus H4461-035 (HMO) offers partially covered dental services, providing a $3,000 annual maximum with no copay and no coinsurance for most diagnostic, preventive, and restorative care, while Medicare-covered dental services require a $30 copay and no coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H4461-035 (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H4461-035 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H4461-035 (HMO) covers durable medical equipment and prosthetics with a 20% coinsurance and no copay. Diabetic supplies and services are covered with a 10% to 20% coinsurance and copays ranging from no copay to $10, depending on the item. Prior authorization is required for these benefits, and diabetic supplies must be obtained from specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-035 (HMO) covers diagnostic and radiological services with prior authorization required, offering no copay for lab services, outpatient X-rays, and diagnostic radiology. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $100, while therapeutic radiological services require a 20% coinsurance and a copay starting at $30.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H4461-035 (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H4461-035 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, but some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease rehabilitation services are not covered and require a $15 copay. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus H4461-035 (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a daily copay of $218 for days 21 through 100, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Humana Gold Plus H4461-035 (HMO) covers acupuncture with a $30 copay and no coinsurance for up to 20 treatments per year, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Other services, such as Dual Eligible SNPs, 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