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Humana Gold Plus H4461-059 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-059 (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 H4461-059 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-059 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Tucson. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-059 (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 H4461-059 (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 H4461-059 (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2550.00 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 H4461-059 (HMO) Medicare plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you pay an $8 copay for Tier 1 preferred generics at standard pharmacies and preferred mail, or a $47 copay for Tier 2 standard generics. Brand-name medications require a 50% coinsurance for Tier 3 preferred brands and a 33% coinsurance for Tier 4 non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100, you transition to the catastrophic coverage phase where you pay nothing for covered Medicare Part D drugs. For individuals who qualify for the low-income subsidy, also known as Extra Help, the Part D drug premium is reduced to $0. This plan is designed to offer clear copayments and coinsurance rates to help you easily manage your prescription medication expenses.
Additional Benefits
The Humana Gold Plus H4461-059 (HMO) plan offers affordable healthcare coverage with no copay for primary care doctor visits and a low $15 copay for specialists. Inpatient hospital stays require a $195 daily copay for the first six days and no copay for days seven through 90, while emergency room visits carry a $150 copay. Key preventive care, home health services, and diagnostic lab tests are also fully covered with no copays or coinsurance. For supplemental health needs, the plan features a $3,000 annual limit for dental services and up to a $350 annual allowance for eyewear with no copay. Hearing exams require a $15 copay, while over-the-counter hearing aids and other over-the-counter items are available with no copay. Specialized medical needs like durable medical equipment require a 15% coinsurance, and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H4461-059 (HMO) partially covers inpatient hospital services, which require a $195 copay and no coinsurance for days 1 through 6, and no copay or coinsurance for days 7 through 90. Unlimited additional acute hospital days are covered with no copay or coinsurance, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H4461-059 (HMO) covers outpatient services with no coinsurance, including outpatient hospital care with copays ranging from $0 to $250 and observation services for a $195 copay. There is no copay for ambulatory surgical center and blood services, while outpatient substance abuse sessions require a copay of $25 to $35.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Humana Gold Plus H4461-059 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus H4461-059 (HMO) covers ground ambulance services with a $335 copay and air ambulance services with a $630 copay, both requiring prior authorization and having no coinsurance. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H4461-059 (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
Humana Gold Plus H4461-059 (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance, excluding routine chiropractic care, while other therapy and mental health services require copays ranging from $20 to $25 and no coinsurance.
Preventive Services See details
Humana Gold Plus H4461-059 (HMO) covers key preventive services, including annual physical exams, kidney disease education, and memory fitness, with no copay and no coinsurance. Additional preventive benefits are only partially covered, excluding services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies.
Hearing Services See details
Humana Gold Plus H4461-059 (HMO) covers hearing exams with a $15 copay and no coinsurance, and over-the-counter hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, excluding inner ear, outer ear, and over-the-ear models.
Vision Services See details
Humana Gold Plus H4461-059 (HMO) offers partially covered vision services with no deductible and no coinsurance, featuring no copay to a $15 copay for eye exams and no copay for covered eyewear up to a $350 annual limit. Covered benefits include routine eye exams, contact lenses, and eyeglasses (lenses and frames), while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4461-059 (HMO) offers partially covered dental services up to a $3,000 annual limit, excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $15 copay and no coinsurance, whereas other covered preventive and comprehensive services have no copay and either no coinsurance or 30% to 40% coinsurance.
Home Infusion bundled Services See details
Humana Gold Plus H4461-059 (HMO) covers home infusion bundled services, including chemotherapy, radiation, and other Part B drugs, with no copay and no coinsurance to 20% coinsurance. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, with prior authorization and step therapy required for home infusion services.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H4461-059 (HMO) plan with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H4461-059 (HMO) covers medical equipment, including durable medical equipment (DME) with a 15% coinsurance and no copay, and prosthetics with a 15% to 20% coinsurance and no copay. 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 H4461-059 (HMO) covers diagnostic and radiological services, with prior authorization required. Lab services and outpatient X-rays are offered with no copay or coinsurance, while diagnostic tests have a copay of $0 to $150, diagnostic radiology has a copay up to $300, and therapeutic radiology requires a $15 copay and 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H4461-059 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H4461-059 (HMO) plan. This includes cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services, none of which are covered by the plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-059 (HMO) covers Skilled Nursing Facility (SNF) services with prior authorization, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100, with no coinsurance. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H4461-059 (HMO) partially covers Other Services, providing acupuncture for a $15 copay and no coinsurance, and over-the-counter items with no copay and no coinsurance. Meal benefits and dual eligible SNPs with highly integrated services are not covered.
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