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Humana Gold Plus H4461-055 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-055 (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 H4461-055 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-055 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in East Texas. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-055 (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 H4461-055 (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 H4461-055 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 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 $4250.00 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 H4461-055 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for 1-month or 3-month supplies filled at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost as low as a $5 copay for a 1-month supply, and there is no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a copay of $45 for a 1-month supply at standard pharmacies and preferred mail order, or $47 through standard mail order. For higher-tier medications, Tier 4 non-preferred drugs require a 49% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. These cost-sharing details help you estimate your out-of-pocket prescription expenses under this Humana Medicare Advantage plan.
Additional Benefits
Humana Gold Plus H4461-055 (HMO) provides affordable healthcare coverage with no copay for primary care visits and a low $20 copay for specialists, with no coinsurance for either. Inpatient hospital stays require a $275 daily copay for the first five days and no copay thereafter, while emergency room visits carry a $130 copay that is waived if you are admitted. Outpatient hospital services feature copays up to $240, and routine home health services are available with no copay or coinsurance. The plan also features strong supplemental benefits, including dental coverage up to a $2,500 annual limit and routine vision exams, both with no copay. Hearing care includes routine exams at no copay and up to two prescription hearing aids per year with copays between $99 and $399. Additionally, members can access up to 60 one-way transportation trips per year to plan-approved locations and receive covered over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H4461-055 (HMO) offers partially covered inpatient hospital benefits with no coinsurance, requiring a $275 daily copay for days 1 to 5 and no copay for days 6 to 90 for acute and psychiatric stays. While unlimited additional acute care days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H4461-055 (HMO) covers outpatient hospital services with a $0 to $240 copay ($275 per stay for observation) and no coinsurance. Outpatient substance abuse sessions require a $20 to $35 copay and no coinsurance, while ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H4461-055 (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
Humana Gold Plus H4461-055 (HMO) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transport to any other health-related location is not covered.
Emergency Services See details
Humana Gold Plus H4461-055 (HMO) covers emergency room visits with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are available with a $50 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H4461-055 (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Therapy, mental health, and psychiatric services require copays ranging from $20 to $25 with no coinsurance, whereas podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Humana Gold Plus H4461-055 (HMO) preventive services are partially covered with no copay and no coinsurance for covered benefits like annual physicals, memory fitness, kidney disease education, and glaucoma screenings. However, sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, 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, disease management, telemonitoring, remote technologies, home modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by the Humana Gold Plus H4461-055 (HMO) plan with no coinsurance. Medicare-covered exams require a $20 copay, while routine annual exams, fitting evaluations, and OTC hearing aids are available with no copay. Up to two prescription hearing aids are covered per year with a copay between $99 and $399, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Humana Gold Plus H4461-055 (HMO), offering no coinsurance for all services, no copay for annual routine eye exams, and a copay of up to $20 for other covered exams. Covered eyewear, such as eyeglasses or contact lenses, features no copay and no coinsurance up to a $350 yearly limit, but other eye exam services, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H4461-055 (HMO), featuring a $2,500 annual maximum with no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental requires a $20 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4461-055 (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and other drugs, have no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus H4461-055 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Humana Gold Plus H4461-055 (HMO) covers durable medical equipment, prosthetic devices, and medical supplies with a 20% coinsurance and no copayment. Diabetic supplies are covered with a 10% to 20% coinsurance and no copayment, while diabetic therapeutic shoes or inserts require a $10 copayment and coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-055 (HMO) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for labs, and a $0 to $50 copay for other diagnostic tests. Radiological services feature no copay for outpatient X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance and $20 copay for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H4461-055 (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H4461-055 (HMO) covers some cardiac rehabilitation services with no coinsurance, but in practice, specific services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-055 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 copay per day for days 1 through 20 and a $218 copay per day for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Humana Gold Plus H4461-055 (HMO) covers acupuncture with a $20 copay and no coinsurance for up to 20 treatments per year, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while other miscellaneous services under this category are not covered.
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