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Humana Gold Plus H4461-041 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-041 (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 H4461-041 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H4461-041 (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 H4461-041 (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 H4461-041 (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 H4461-041 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3200.00 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 H4461-041 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred mail order pharmacies and a $20 copay at standard mail order pharmacies. After 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 H4461-041 (HMO) plan offers coverage for a wide range of services. You'll have a $175 copay for inpatient hospital stays for days 1-5, and no copay for days 6-90. Outpatient services, primary care, and preventive services all have no copay, but some services like specialist visits and hearing exams have copays. The plan also includes coverage for hearing, vision, and dental services with no or low copays. It covers ambulance services with copays, emergency services, and home health services with no copays. Additionally, the plan provides coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities with varying copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital coverage includes both acute and psychiatric care, with a $175 copay for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital-acute have no copay. Non-Medicare-covered stays and upgrades for inpatient hospital-acute and additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $175, observation services with a $175 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $25 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H4461-041 (HMO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a copay of $315, 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. Emergency Services have a $140 copay, and Urgently Needed Services have a $65 copay, and no coinsurance applies to either. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $140 copay.
Primary Care See details
Under the Humana Gold Plus H4461-041 (HMO) plan, primary care physician services have no copay, while chiropractic services have a $20 copay. Occupational therapy services have a $20 copay, and physician specialist services have a $25 copay. Mental health and psychiatric services have a $25 copay for both individual and group sessions, and physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits have a copay between $0 and $65, and opioid treatment program services have a $25 copay.
Preventive Services See details
The Humana Gold Plus H4461-041 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are also covered, but the copay information is listed separately. There is also a Fitness Benefit, which includes memory fitness, with no copay. The plan does not cover health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission 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, or counseling services.
Hearing Services See details
The Humana Gold Plus H4461-041 (HMO) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, and OTC hearing aids are covered up to $50 every three months.
Vision Services See details
The Humana Gold Plus H4461-041 (HMO) plan covers routine eye exams with no copay, and eyewear including contact lenses and eyeglasses (lenses and frames) with no copay, up to a combined maximum of $250 per year. 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. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay, and a yearly maximum benefit of $3,000. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H4461-041 (HMO) plan. You will pay 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and Prosthetic Devices have a 20% coinsurance. 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, diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay, while Diagnostic Radiological Services have a copay of at most $325 and Therapeutic Radiological Services have a copay of at least $25, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H4461-041 (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 specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H4461-041 (HMO) plan, with a copay of $20 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H4461-041 (HMO) plan covers acupuncture with a $25 copay, and covers over-the-counter items up to $50 every three months. The plan also covers a meal benefit with no copay. However, many other services are not covered, including Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others.
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