A non-government entity
Humana Gold Plus H4461-050 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-050 (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 H4461-050 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-050 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Dallas area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-050 (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 H4461-050 (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 H4461-050 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.00. 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 $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:
Sign up for Humana Gold Plus H4461-050 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H4461-050 (HMO) medicare plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies, with no copay required for a 3-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at standard pharmacies and through preferred mail order. For higher-tier medications, you will pay a 48% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs. This plan provides multiple cost-sharing tiers to help manage your prescription medication expenses.
Additional Benefits
The Humana Gold Plus H4461-050 (HMO) plan offers affordable healthcare coverage with no copay for primary care visits, preventive annual physicals, and home health services. Specialist visits require a low $15 copay, while inpatient hospital stays cost a $225 daily copay for the first five days and no copay for subsequent days. Emergency room visits carry a $150 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also features robust supplemental benefits, including up to $3,500 in annual dental coverage and a $300 yearly allowance for eyewear with no copay. Members benefit from no copay for routine hearing exams, unlimited over-the-counter hearing aids, and up to 60 one-way transportation trips per year to approved locations. Additionally, essential services like lab tests, cardiac rehabilitation, and over-the-counter items are covered with no copay.
Inpatient Hospital See details
Humana Gold Plus H4461-050 (HMO) covers inpatient hospital services with no coinsurance, requiring a $225 daily copay for days 1 through 5 and no copay for days 6 and beyond. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H4461-050 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which both feature no copay. Outpatient hospital services have a copay ranging from $0 to $225, observation services require a $225 copay per stay, and outpatient substance abuse sessions carry a $20 to $35 copay.
Partial Hospitalization See details
Humana Gold Plus H4461-050 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus H4461-050 (HMO), featuring a $335 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Transportation services are partially covered with no copay and no coinsurance for up to 60 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H4461-050 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services each require a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H4461-050 (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Physical, occupational, and speech therapies require a $25 copay and no coinsurance, while podiatry is not covered. For chiropractic services, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H4461-050 (HMO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive services are partially covered, offering a memory fitness benefit with no copay and no coinsurance, but excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus H4461-050 (HMO) offers hearing services with no coinsurance, featuring a $15 copay for Medicare-covered exams, no copay for annual routine exams, and no copay for unlimited over-the-counter hearing aids. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $999 for up to two aids per year, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Humana Gold Plus H4461-050 (HMO) partially covers vision services with no coinsurance and copays ranging from $0 to $15, with prior authorization required. The plan covers one routine eye exam per year and up to $300 annually for contact lenses or eyeglasses (lenses and frames) with no copay, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4461-050 (HMO) covers Medicare-covered dental services with a $15.00 copay and no coinsurance, while other dental services are partially covered with no copay and no coinsurance up to a $3,500 annual maximum. Fluoride treatments, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus H4461-050 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H4461-050 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Humana Gold Plus H4461-050 (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.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-050 (HMO) covers diagnostic and radiological services, requiring prior authorization for most services. Lab services and outpatient X-rays feature no copay, diagnostic tests carry a $0 to $100 copay with no coinsurance, and therapeutic radiology requires a minimum $15 copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H4461-050 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Humana Gold Plus H4461-050 (HMO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, 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 H4461-050 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. The benefit is partially covered because prior authorization is required and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services covered by Humana Gold Plus H4461-050 (HMO) include acupuncture with a $15 copay and no coinsurance for up to 20 treatments yearly. Meal benefits for chronic illnesses and over-the-counter items are also covered with no copay and no coinsurance, while other miscellaneous 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
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved