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Humana Gold Plus Giveback H4461-039 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H4461-039 (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 Giveback H4461-039 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus Giveback H4461-039 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Nashville. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus Giveback H4461-039 (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 Giveback H4461-039 (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 Giveback H4461-039 (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 $59.00. 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 $565.00 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 Giveback H4461-039 (HMO) plan has a $565 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will pay a $7 copay for preferred generic drugs at preferred pharmacies and a 42% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus Giveback H4461-039 (HMO) plan offers comprehensive coverage for various healthcare needs. This plan includes coverage for inpatient hospital stays with a copay, outpatient services, and emergency services with a copay. This plan also provides coverage for primary care with no copay, hearing and vision services, and dental services with no copay for many services. Additionally, the plan covers home health services, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient hospital services are covered, with a copay of $375 for days 1-5 and no copay for days 6-90 for acute care, and a copay of $375 for days 1-4 and no copay for days 5-90 for psychiatric care. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $350, observation services with a $375 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $30 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $30 copay. Prior authorization is required.
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 any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Humana Gold Plus Giveback H4461-039 (HMO) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Services are also covered, with a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, and no coinsurance.
Primary Care See details
The Humana Gold Plus Giveback H4461-039 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $20 copay. The plan also covers physician specialist services with a $50 copay, mental health specialty services with a $30 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $20 copay. Additional telehealth benefits are covered with a copay between $0 and $50, and Opioid Treatment Program Services are covered with a $30 copay. Podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus Giveback H4461-039 (HMO) plan covers preventive services including an annual physical exam with no copay, and additional services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a welcome visit with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $50 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, with a copay between $499 and $799 for all types of prescription hearing aids except for inner ear, outer ear, and over the ear models. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus Giveback H4461-039 (HMO) plan covers vision services including eye exams with a copay of $0-$50, and eyewear including contact lenses and eyeglasses with no copay, but does not cover eyeglass lenses, eyeglass frames, or upgrades. Routine eye exams are covered with no copay.
Dental Services See details
The Humana Gold Plus Giveback H4461-039 (HMO) plan covers Medicare Dental Services with a $50 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with 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, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 19%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus Giveback H4461-039 (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable medical equipment has a 10% coinsurance, while durable medical equipment for use outside the home is not covered. Prosthetic devices have a 9% coinsurance, and medical supplies have no copay. Diabetic supplies have a 10-20% coinsurance and no copay, while diabetic therapeutic shoes/inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $65, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $325, Therapeutic Radiological Services have a copay up to $65, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus Giveback H4461-039 (HMO) 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 covered, but the specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. Prior authorization is required, and copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus Giveback H4461-039 (HMO) plan covers acupuncture with a $50 copay and a 20-treatment limit per year, and meal benefits with no copay. Over-the-counter items, 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.
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