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Humana Gold Plus H4461-058 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-058 (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 H4461-058 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-058 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in San Antonio 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 H4461-058 (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 H4461-058 (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 H4461-058 (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 $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 H4461-058 (HMO) plan features a $615 drug deductible, with excellent savings on generic medications. Under this plan, there is no copay for Tier 1 preferred generics and Tier 2 generics when filled as a 1-month or 3-month supply at standard pharmacies or via preferred mail order. If you choose standard mail order for these generic tiers, copays range from $10 to $60. For brand-name and specialty medications, costs are structured around copays and coinsurance. Tier 3 preferred brand drugs have a $45 copay for a 1-month supply at standard pharmacies and preferred mail order, while Tier 4 non-preferred drugs require 46% coinsurance. Tier 5 specialty drugs require 25% coinsurance for a 1-month supply across all available pharmacy options.
Additional Benefits
The Humana Gold Plus H4461-058 (HMO) plan offers affordable coverage for your essential medical needs, featuring no copay and no coinsurance for primary care visits and key preventive services. For inpatient hospital stays, you will pay a daily copay of $95 for days one through five, followed by no copay for days six through 90. Emergency room visits carry a $150 copay, which is waived if you are admitted, while outpatient surgical services and home health visits are available with no copay. This plan also includes supplemental benefits, offering dental coverage with no copay up to a $4,000 annual maximum and vision coverage with no copay on eyewear up to $300 annually. Routine hearing exams and over-the-counter hearing aids are covered with no copay, while specialist and therapy visits require copays ranging from $15 to $35. For specialized needs like durable medical equipment and dialysis services, you can expect a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Plus H4461-058 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $95 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H4461-058 (HMO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services carry a $0 to $100 copay, observation services require a $95 copay per stay, and outpatient substance abuse sessions have a $20 to $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Gold Plus H4461-058 (HMO) plan with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H4461-058 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 60 one-way trips per year to plan-approved locations, but trips to any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H4461-058 (HMO) with a $150 copay and no coinsurance, with the copay waived if 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 H4461-058 (HMO) offers primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, and opioid treatment services require copays ranging from $15 to $35 with no coinsurance. Telehealth services range from no copay to a $65 copay with no coinsurance, podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H4461-058 (HMO) covers key preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are only partially covered, providing a memory fitness benefit with no copay and no coinsurance, while other options such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Humana Gold Plus H4461-058 (HMO) covers hearing services with no coinsurance, offering Medicare-covered exams for a $15 copay, alongside routine exams, fitting evaluations, and OTC hearing aids at no copay. Prescription hearing aids are partially covered with copays ranging from $499 to $1,099 for up to two devices per year, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H4461-058 (HMO) partially covers Vision Services, featuring eye exams with a $0 to $15 copay and eyewear with no copay, both with no coinsurance. While routine eye exams and eyeglasses (lenses and frames) or contact lenses are covered up to a $300 annual maximum, other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4461-058 (HMO) offers partially covered dental services with a $15 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $4,000 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus H4461-058 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Humana Gold Plus H4461-058 (HMO) covers dialysis services 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 H4461-058 (HMO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with a 20% coinsurance and no copayment. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-058 (HMO) covers diagnostic and radiological services, though prior authorization and referrals are required. Lab services feature no copay and no coinsurance, diagnostic tests have no coinsurance with a copay of $0 to $75, outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance and a minimum $20 copay.
Home Health Services See details
Humana Gold Plus H4461-058 (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus H4461-058 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. Covered services require prior authorization and a referral, carrying a $15 copay for cardiac rehab and a $20 copay for pulmonary and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-058 (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, though a prior three-day inpatient hospital stay is not, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Humana Gold Plus H4461-058 (HMO) partially covers other services, including acupuncture for a $15 copay and no coinsurance, up to 20 treatments per year with prior authorization. Over-the-counter items and chronic illness meal benefits are available with no copay and no coinsurance, though meal benefits require prior authorization and other specific supplemental services are not covered.
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