A non-government entity
Humana Gold Plus H4461-057 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-057 (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 H4461-057 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-057 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Houston Metro area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-057 (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 H4461-057 (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 H4461-057 (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 $1.00. 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 $340.00 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 $3450.00 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 H4461-057 (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 H4461-057 (HMO) prescription drug plan features an annual drug deductible of $340. Under this plan, there is no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through preferred mail order. Tier 2 generic medications are also highly affordable, starting at a $5 copay for a one-month supply, with no copay required for a three-month supply via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a one-month supply at standard pharmacies and mail-order services. Tier 4 non-preferred drugs carry a 48% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply.
Additional Benefits
The Humana Gold Plus H4461-057 (HMO) plan offers comprehensive medical coverage with no copays and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, mental health sessions, and physical therapy require a $20 copay, while inpatient hospital stays carry a $150 daily copay for days one through five and no copay for days six through 90. Emergency room visits require a $150 copay, which is waived if admitted, while outpatient hospital services range from no copay up to a $200 copay. Additional benefits include routine dental and vision care with no copays, featuring a $2,000 annual dental limit and a $350 yearly allowance for eyeglasses or contacts. Members also benefit from up to 60 free one-way transportation trips to plan-approved locations and no copays for over-the-counter hearing aids. For specialized medical needs, durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Plus H4461-057 (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. While acute care offers unlimited additional days with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H4461-057 (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $200, observation services carry a $150 copay per stay, and outpatient substance abuse sessions have a $20 to $35 copay.
Partial Hospitalization See details
Humana Gold Plus H4461-057 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H4461-057 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or 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 H4461-057 (HMO) covers emergency services with a $150 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $65 copay with 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 H4461-057 (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, mental health services, and physical, occupational, and speech therapies require a $20 copay and no coinsurance. Additional telehealth services (copays ranging from $0 to $65) and opioid treatment (copays ranging from $20 to $35) are also covered with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H4461-057 (HMO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. This benefit is partially covered because while a memory fitness benefit is included with no copay, various supplemental services like health education, personal emergency response systems (PERS), medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Humana Gold Plus H4461-057 (HMO) hearing services cover Medicare-covered exams with a $20 copay and routine exams and fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $699 and $999, excluding inner ear, outer ear, and over-the-ear types, while over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H4461-057 (HMO) vision services are partially covered, featuring no deductibles, no coinsurance, and no copays for covered services, though prior authorization is required. Covered benefits include one annual routine eye exam and up to $350 yearly for contact lenses or bundled eyeglasses, while other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4461-057 (HMO) partially covers dental services up to a $2,000 annual maximum, requiring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Gold Plus H4461-057 (HMO) with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus H4461-057 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under the Humana Gold Plus H4461-057 (HMO) plan, with durable medical equipment and prosthetics requiring a 20% coinsurance and no copay, subject to prior authorization. Covered diabetic supplies from specified manufacturers require a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts have a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-057 (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay and diagnostic services with no coinsurance. Diagnostic procedures and tests have a copay ranging from $0 to $150, while therapeutic radiological services require a minimum 20% coinsurance and a $20 copay.
Home Health Services See details
Humana Gold Plus H4461-057 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H4461-057 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $20 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H4461-057 (HMO) with no coinsurance, requiring a daily copay of $20 for days 1 to 20 and $218 for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H4461-057 (HMO) provides partially covered Other Services, which include acupuncture with a $20 copay and no coinsurance, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Other unspecified services and dual-eligible SNP benefits are not covered by this plan.
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