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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 2025, 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 4.5 out of 5 stars in 2025.
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 $85.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy used. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy, but $20 at a standard mail order pharmacy. For standard generic drugs, the copay is $47, and for preferred brand drugs, you pay 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus H4461-040 (HMO) plan offers comprehensive coverage, including no copay for inpatient hospital stays, outpatient blood services, preventive services, and many other services. The plan also covers a range of services with copays, such as emergency services, primary care visits, hearing exams, and dental services. Additional benefits include coverage for hearing aids, vision care, and dental services, with varying copays and maximum benefits. The plan also covers home health services, cardiac rehabilitation services, and skilled nursing facility services, with specific copays and prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute with no copay for a Medicare-covered stay and additional days covered with no copay, and Inpatient Hospital Psychiatric with a $250 copay per admission or stay. 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.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by this plan. Outpatient hospital services have a copay between $0 and $225, while observation services and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a $25 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H4461-040 (HMO) plan with a $25 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H4461-040 (HMO), with a $315 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Humana Gold Plus H4461-040 (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
The Humana Gold Plus H4461-040 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $10 copay, and physician specialist services with a $25 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $25 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $10 copay. This plan also covers additional telehealth benefits with a copay between $0 and $25.
Preventive Services See details
Preventive Services include no copay for annual physical exams. Other services, such as In-Home Support Services and Fitness Benefits, are covered with no copay.
Hearing Services See details
Humana Gold Plus H4461-040 (HMO) covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. The plan also covers prescription hearing aids with a copay of $0-$299, and OTC hearing aids with a maximum benefit of $100 every three months.
Vision Services See details
Vision services include eye exams with a copay of $0-$25, and eyewear, including contact lenses and eyeglasses (lenses and frames), with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $25 copay, and other dental services with a $4,000 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. Restorative services and prosthodontics, removable, are covered with no copay and 30-40% and 30% coinsurance respectively. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H4461-040 (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H4461-040 (HMO) plan, but require prior authorization. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, is covered by this plan. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Equipment is also covered, but Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests, and lab services with no copay. Diagnostic Radiological Services have a maximum copay of $225, while Therapeutic Radiological Services have a copay of $25, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H4461-040 (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 by the Humana Gold Plus H4461-040 (HMO) plan, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214.
Other Services See details
The Humana Gold Plus H4461-040 (HMO) plan covers acupuncture with a $25 copay and a limit of 20 treatments per year, and also covers over-the-counter items with a maximum benefit of $100 every three months. The plan provides a meal benefit with no copay, and also has other services that are not covered.
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