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Humana Gold Plus H4461-056 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-056 (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 H4461-056 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-056 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Phoenix. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-056 (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 H4461-056 (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 H4461-056 (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 $2.00. 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 $2900.00 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 H4461-056 (HMO) plan offers an Enhanced Alternative drug benefit with no prescription drug deductible, allowing your coverage to start immediately. During the initial coverage phase, Tier 1 preferred generic drugs cost as little as an $8 copay, while Tier 2 standard generics carry a $47 copay. For higher tiers, you will pay a 50% coinsurance for Tier 3 preferred brands and a 33% coinsurance for Tier 4 non-preferred drugs. Once your annual out-of-pocket prescription drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Individuals who qualify for the low-income subsidy (Extra Help) will also benefit from a reduced Part D cost of $0.
Additional Benefits
The Humana Gold Plus H4461-056 (HMO) plan offers comprehensive healthcare coverage with no copay for primary care visits, preventive services, and home health care, while specialist visits require a $15 copay. For hospital stays, inpatient care requires a $195 daily copay for the first six days, followed by no copay for days seven through 90. Emergency room visits carry a $150 copay, which is waived if you are admitted, and urgent care is available for a $65 copay. This plan also includes valuable supplemental benefits, featuring routine vision and routine hearing exams with no copay, alongside a $150 annual allowance for eyewear. Most preventive and comprehensive dental services are covered with no copay up to a $3,000 annual maximum, and over-the-counter items are also available with no copay. For medical supplies and durable medical equipment, you can expect a coinsurance ranging from 10% to 20% with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Humana Gold Plus H4461-056 (HMO), requiring a $195 daily copay for days 1 through 6, no copay for days 7 through 90, and no coinsurance. While unlimited additional acute hospital days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H4461-056 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $195, observation services have a $195 copay per stay, and outpatient substance abuse services have a copay of $25 to $35 per session.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Gold Plus H4461-056 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus H4461-056 (HMO) with no coinsurance, requiring a $335 copay for ground ambulance and a $630 copay for air ambulance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H4461-056 (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay 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
Primary care benefits are offered by Humana Gold Plus H4461-056 (HMO) with no copay or coinsurance for primary care provider visits. Specialist visits, physical therapy, and occupational therapy require a $15 copay and no coinsurance, while chiropractic services are partially covered with a $20 copay and no coinsurance as routine chiropractic care is excluded.
Preventive Services See details
Humana Gold Plus H4461-056 (HMO) provides partial coverage for preventive services with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and select fitness benefits. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, weight management, alternative therapies, and therapeutic massage.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H4461-056 (HMO), featuring a $15 copay for exams and no copay or coinsurance for annual routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with copays between $699 and $999 and no coinsurance, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Humana Gold Plus H4461-056 (HMO), featuring routine eye exams with no copay, other eye exams with a copay of $0 to $15, and no coinsurance. The plan also provides a $150 annual limit with no copay for contact lenses and complete eyeglasses, though individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H4461-056 (HMO) up to a $3,000 annual maximum, with a $15 copay and no coinsurance for Medicare-covered dental. Most preventive and comprehensive services feature no copay and no coinsurance, though prosthodontics require a 30% coinsurance with no copay, and fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4461-056 (HMO) covers Home Infusion bundled Services with prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H4461-056 (HMO) with a 20% coinsurance and no copay, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus H4461-056 (HMO) covers medical equipment with prior authorization required, including durable medical equipment at a 15% coinsurance and no copay. Prosthetics require a 20% coinsurance and no copay, medical supplies require a 15% coinsurance and no copay, and diabetic supplies range from a 10% to 20% coinsurance with no copay. Diabetic therapeutic shoes and inserts carry a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-056 (HMO) covers diagnostic and radiological services, with prior authorization required for all services. Lab and outpatient X-ray services have no copay and no coinsurance, while diagnostic procedures and diagnostic radiological services feature copays of $0 to $150 and $0 to $300, respectively, with no coinsurance. Therapeutic radiological services require a $15 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H4461-056 (HMO) with no copay and no coinsurance. Prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H4461-056 (HMO) plan, meaning there is no coverage, copays, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-056 (HMO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond Medicare-covered limits are not covered. Prior authorization is required, and you will pay a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance.
Other Services See details
Humana Gold Plus H4461-056 (HMO) partially covers Other Services, offering acupuncture for up to 20 treatments per year with a $15 copay and no coinsurance, and over-the-counter items with no copay or coinsurance. Meal benefits and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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