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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 2026, 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 out of 5 stars in 2026.
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 $15.20. 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 H4461-038 (HMO D-SNP) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a standard pharmacy or preferred mail order for 1-month or 3-month supplies. If you opt for standard mail order, Tier 1 drugs have a $10 copay for a 1-month supply, while Tier 2 drugs carry a $20 copay. For Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, the plan charges a consistent 25% coinsurance. This 25% coinsurance rate applies to standard pharmacies, preferred mail order, and standard mail order services. Knowing these exact copayment and coinsurance details helps you accurately estimate your yearly prescription costs under this Humana HMO D-SNP plan.
Additional Benefits
The Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) plan offers structured medical coverage featuring defined copays and coinsurance. Inpatient acute hospital stays require a $2,230 copay, while psychiatric stays have a $2,080 copay, both with no coinsurance. For primary care and specialist visits, members pay no copay and a 20% coinsurance, whereas outpatient hospital services require a $550 copay and 20% coinsurance. Preventive care and home health services are fully covered with no copay and no coinsurance. Vision and hearing benefits feature no deductibles, offering routine exams with no copay and a 20% coinsurance alongside allowances for eyewear and hearing aids. Dental care is also covered, featuring no copay and a 20% coinsurance for Medicare-covered services and no copay or coinsurance for other covered dental services up to a $2,000 annual limit.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) with no coinsurance, though prior authorization is required. Medicare-covered acute stays require a $2,230 copay per stay with unlimited additional days at no copay, while psychiatric stays require a $2,080 copay per stay; non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP), featuring a $550 copay and 20% coinsurance for outpatient hospital services, and a $400 copay and 20% coinsurance for ambulatory surgical center services. Outpatient substance abuse and blood services are covered with no copay and 20% coinsurance, with no deductible applied to blood services.
Partial Hospitalization See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance services under Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) require prior authorization and cover ground ambulance with a $335 copay and no coinsurance, and air ambulance with a 20% coinsurance and no copay. Transportation services are not covered, including transport to plan-approved or any other health-related locations.
Emergency Services See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are available with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) covers primary care, specialist, therapy, and telehealth services with no copay and 20% coinsurance. Chiropractic benefits are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) provides partial coverage for preventive services, featuring no copay and no coinsurance for covered care such as annual physical exams, kidney disease education, glaucoma screenings, and diabetes training. While supplemental benefits like memory fitness and in-home support are also covered at no cost, several services including health education, nutritional therapy, and personal emergency response systems are not covered.
Hearing Services See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) covers hearing services with no deductible, featuring routine hearing exams once annually with no copay and a 20% coinsurance, and unlimited fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two aids every three years, though inner ear, outer ear, and over the ear types are not covered. Over-the-counter (OTC) hearing aids are fully covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) partially covers vision services with no deductibles, offering one annual routine eye exam with no copay and 20% coinsurance. Covered eyewear has no copay and no coinsurance up to a $150 yearly limit for one pair of contact lenses or eyeglasses (lenses and frames), 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 H4461-038 (HMO D-SNP), which features no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $2,000 annual limit. While preventive and comprehensive benefits like exams, cleanings, and x-rays are covered, several sub-services are not covered, including fluoride treatment, endodontics, implants, oral and maxillofacial surgery, orthodontics, maxillofacial prosthetics, and fixed or removable prosthodontics.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) covers home infusion bundled services with prior authorization required, featuring a 0% to 20% coinsurance for Part B chemotherapy, radiation, and other drugs. Covered Part B insulin carries a $35 copay and 0% to 20% coinsurance, while other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) 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 H4461-038 (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic supplies with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with no copay, though prior authorization is required for most equipment and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) covers diagnostic and radiological services with a 20% coinsurance, requiring prior authorization. Under this plan, lab services and diagnostic tests have no copay, while outpatient X-rays require a $50 copay and diagnostic radiological services carry a $200 copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) covers cardiac rehabilitation services with no copay and a 20% coinsurance, though prior authorization is required. While some services are covered, specific sub-services including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) provides covered other services including acupuncture with no copay and 20% coinsurance for up to 20 treatments per year. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, though highly integrated services and certain other 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
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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.
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