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Humana Gold Plus H4461-040 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-040 (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 H4461-040 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-040 (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 H4461-040 (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 H4461-040 (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 H4461-040 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $74.00. 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 $1900.00 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 H4461-040 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Standard mail order for these generic tiers requires a copay of $10 to $20 for a 1-month supply. Tier 3 preferred brand drugs incur a $47 copay for a 1-month supply at standard pharmacies and mail-order services. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus H4461-040 (HMO) plan offers robust coverage with no copay or coinsurance for inpatient hospital stays, primary care visits, and preventive services. Patients can also expect low out-of-pocket costs for specialist visits, which carry a $20 copay, and outpatient services ranging from no copay to a $35 copay. Emergency care is available with a $150 copay, which is waived if the patient is admitted to the hospital within 24 hours. This plan features generous supplemental benefits, including routine hearing, vision, and dental services with no copay, alongside a $5,000 annual maximum for covered dental care and a $350 allowance for eyewear. Skilled nursing facility care is covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Additionally, members benefit from no copay on over-the-counter items, home health services, and chronic illness meals.
Inpatient Hospital See details
Humana Gold Plus H4461-040 (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, subject to prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Humana Gold Plus H4461-040 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $35 copay for outpatient hospital services and no copay for ambulatory surgical center, observation, and blood services. Outpatient substance abuse individual and group sessions require a $35 copay with no coinsurance, and prior authorization is required for most of these services.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H4461-040 (HMO) with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus H4461-040 (HMO) covers ground ambulance services with a $335 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay, both requiring prior authorization. For transportation services, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services under the Humana Gold Plus H4461-040 (HMO) plan are covered with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H4461-040 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits for a $20 copay and no coinsurance. Physical, occupational, and speech therapy require a $10 copay and no coinsurance, while psychiatric, mental health, and opioid treatment services have a $35 copay and no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Humana Gold Plus H4461-040 (HMO) with no copay and no coinsurance, including annual physicals, kidney disease education, and diabetes self-management. Additional preventive services are partially covered with no copay or coinsurance for fitness and in-home support, but do not cover health education, safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, or counseling.
Hearing Services See details
Humana Gold Plus H4461-040 (HMO) covers Medicare-covered hearing exams with a $20 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from no copay up to $299, but inner ear, outer ear, and over the ear hearing aids are not covered. Over-the-counter hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H4461-040 (HMO) partially covers vision services with no coinsurance, offering eye exams with a $0 to $20 copay (no copay for annual routine exams) and eyewear with no copay up to a $350 annual maximum. While contact lenses and eyeglasses (lenses and frames) are covered, other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4461-040 (HMO) dental services are partially covered, featuring a $20 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for other covered services up to a $5,000 annual maximum. While most preventive and comprehensive services are covered, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4461-040 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, 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
Dialysis services are covered by Humana Gold Plus H4461-040 (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus H4461-040 (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. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-040 (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures carry a $0 to $65 copay with no coinsurance, lab services and diagnostic radiology have no copay and no coinsurance, and therapeutic radiology requires a minimum $20 copay and 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H4461-040 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Humana Gold Plus H4461-040 (HMO) with no coinsurance and a $10 copay, though prior authorization is required. Under this plan, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-040 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a three-day prior hospital stay is not necessary, additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered under Humana Gold Plus H4461-040 (HMO), featuring acupuncture for a $20 copay and no coinsurance for up to 20 treatments yearly with prior authorization. Over-the-counter items and chronic illness meal benefits are covered with no copay and no coinsurance, while other additional services and Dual Eligible SNPs are not covered.
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