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Humana Gold Plus H4461-053 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-053 (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 H4461-053 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-053 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in San Antonio, Corpus Christi, RGV, El Paso Metro. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-053 (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 H4461-053 (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 H4461-053 (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 $3400.00 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 H4461-053 (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. If you utilize standard mail order, one-month copays are $10 for Tier 1 and $20 for Tier 2. Tier 3 preferred brand drugs cost a $45 copay for a one-month supply at standard pharmacies and preferred mail order, and a $47 copay through standard mail order. Tier 4 non-preferred drugs require 50% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply. Understanding these copays and coinsurance rates helps you estimate your out-of-pocket prescription drug costs with this Humana Medicare Advantage plan.
Additional Benefits
The Humana Gold Plus H4461-053 (HMO) plan offers robust medical coverage with no copay for primary care doctor visits and a low $15 copay for specialists. Inpatient hospital stays require a $95 daily copay for the first five days and no copay for days six through 90, while emergency room visits carry a $150 copay. Outpatient services are also highly affordable, featuring no copay for ambulatory surgical center visits and a copay of up to $120 for outpatient hospital services. For extra lifestyle benefits, members enjoy a generous $5,000 annual dental limit and a $400 eyewear allowance with no copay. Routine hearing exams and up to 100 one-way transportation trips to approved locations are also covered with no copay. Standard medical needs like dialysis and durable medical equipment are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H4461-053 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $95 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Humana Gold Plus H4461-053 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services feature a copay of $0 to $120, while observation services cost a $95 copay per stay and outpatient substance abuse sessions carry a $20 to $35 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Gold Plus H4461-053 (HMO) with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H4461-053 (HMO) covers ambulance services with a $335 copay and no coinsurance for both ground and air transport, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 100 one-way trips per year to plan-approved locations, though trips to any other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H4461-053 (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 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 H4461-053 (HMO) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Physical, occupational, and speech therapies, along with mental health and psychiatric services, require a $20 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H4461-053 (HMO) provides partially covered preventive services with no copay and no coinsurance for covered benefits, which include annual physicals, kidney disease education, glaucoma screenings, and memory fitness. However, several supplemental benefits are not covered, such as health education, in-home safety assessments, medical nutrition therapy, and weight management programs.
Hearing Services See details
Humana Gold Plus H4461-053 (HMO) covers hearing exams with a $15 copay and no coinsurance for Medicare-covered tests, and no copay and no coinsurance for routine annual exams and fittings. Prescription hearing aids are partially covered with no coinsurance and copays ranging from no copay to $299 (inner ear, outer ear, and over-the-ear types are not covered), while over-the-counter hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H4461-053 (HMO) with no coinsurance and copays ranging from no copay to $15, though prior authorization and referrals are required. This benefit includes one routine eye exam and a $400 annual limit for one pair of contacts or eyeglasses (lenses and frames) with no copay, while other eye exams, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H4461-053 (HMO), featuring a $5,000 annual maximum with no copay or coinsurance for most preventive and comprehensive services, and a $15 copay with no coinsurance for Medicare-covered dental. However, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4461-053 (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 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H4461-053 (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H4461-053 (HMO) covers medical equipment, including durable medical equipment and prosthetic devices with a 20% coinsurance and no copay, and medical supplies with a 20% coinsurance. 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 H4461-053 (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a copay ranging from $0 to $75 for diagnostic procedures. Covered radiological services include outpatient X-rays and diagnostic radiology with no copay, while therapeutic radiological services require a 20% coinsurance and a $20 copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H4461-053 (HMO) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by the Humana Gold Plus H4461-053 (HMO) plan with no coinsurance, though prior authorization and referrals are required. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for symptomatic Peripheral Artery Disease (PAD) are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-053 (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. Prior authorization and referrals are required, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Humana Gold Plus H4461-053 (HMO) covers acupuncture with a $15 copay and no coinsurance for up to 20 treatments yearly, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Other services, including highly integrated Dual Eligible SNPs and additional unspecified benefits, are not covered under this plan.
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