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Humana Gold Plus SNP-DE H4461-038 (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 H4461-038 (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 H4461-038 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H4461-038 (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 H4461-038 (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 H4461-038 (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 H4461-038 (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 H4461-038 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.60. 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:
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Drug Coverage
The Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs in each tier until your total drug costs reach $2000.00. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). For those who qualify for full LIS, the monthly premium for Part D is $34.60.
Additional Benefits
The Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including preventive care, routine hearing exams, eyewear, and home health services, are covered with no copay. Many other services have a coinsurance of 20%, and some services have a copay, such as inpatient hospital acute services, emergency services, and ground ambulance services. This plan includes coverage for inpatient and outpatient services, along with additional benefits such as vision, dental, and hearing services. The plan also offers coverage for ambulance services, emergency services, and home infusion bundled services. Other services include acupuncture and an over-the-counter (OTC) benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered, but non-Medicare-covered stays and upgrades for inpatient hospital acute, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered. For inpatient hospital acute services, the copay is $2185 per admission or stay, and for inpatient hospital psychiatric services, the copay is $2036 per admission or stay.
Outpatient Services See details
The Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) plan covers outpatient services, including outpatient hospital services with a $550 copay and 20% coinsurance, and observation services with 20% coinsurance. Ambulatory Surgical Center (ASC) services have a $400 copay and 20% coinsurance. Outpatient substance abuse services, including individual and group sessions, have a 20% coinsurance. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) plan and requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, and air ambulance services have a 20% coinsurance. Transportation services to any 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 H4461-038 (HMO D-SNP) plan. Emergency Services has a $110 copay, Urgently Needed Services has a 20% coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have a 20% coinsurance. Chiropractic services and podiatry services have a 20% coinsurance, with routine chiropractic care having no copay. Occupational therapy services, individual and group sessions for mental health specialty services, and individual and group sessions for psychiatric services have a 20% coinsurance. Other health care professional services and opioid treatment program services have a minimum and maximum coinsurance of 20%.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are also covered, with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
Hearing exams and prescription hearing aids are covered, with routine hearing exams covered once per year with no copay and a coinsurance of at most 20%. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) are covered with no copay every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay and 20% coinsurance, while routine eye exams have no copay. Eyewear has no copay, and a combined maximum plan benefit coverage of $150 per year for contact lenses and eyeglasses.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance and other dental services with a $2,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay, but fluoride treatment, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%, and there is no copay.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment, which has varying cost-sharing depending on the service. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have a coinsurance of at most 20% and no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $720, and Outpatient X-Ray Services have a coinsurance of at most 20% and a $50 copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H4461-038 (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 H4461-038 (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) plan, requiring prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a 20% coinsurance and is limited to 20 treatments per year, while the OTC benefit has a maximum coverage amount of $1800 per year, and the meal benefit has no copay.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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