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Humana Gold Plus H4461-060 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-060 (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 H4461-060 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-060 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Corpus Christi 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 H4461-060 (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 H4461-060 (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 H4461-060 (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 $600.00 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 H4461-060 (HMO) plan features an annual prescription drug deductible of $600. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for one-month or three-month supplies filled at standard pharmacies or through preferred mail order. If you utilize standard mail order instead, you will pay a $10 copay for Tier 1 and a $20 copay for Tier 2 for a one-month supply. Tier 3 preferred brand drugs cost a $37 copay for a one-month supply at standard pharmacies or preferred mail order, increasing to $47 through standard mail order. For higher-tier prescriptions, you will pay coinsurance rather than a copay, which includes 50% coinsurance for Tier 4 non-preferred drugs and 26% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The Humana Gold Plus H4461-060 (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs and no deductible for key services. Members pay no copay and no coinsurance for primary care visits, preventive services, and home health care, while specialist visits require a low $15 copay. For hospital stays, inpatient care features a $75 daily copay for the first five days followed by no copay, and emergency room visits carry a $150 copay that is waived if you are admitted. This plan also includes valuable supplemental benefits to support your overall well-being at minimal extra cost. Routine dental care is covered with no copay and no coinsurance up to a $2,000 annual limit, and routine vision and hearing exams are also available with no copay. Additionally, members can take advantage of up to 60 free one-way transportation trips per year and no-copay coverage for over-the-counter items and chronic illness meals.
Inpatient Hospital See details
Humana Gold Plus H4461-060 (HMO) covers inpatient hospital stays with no coinsurance and a copay of $75 per day for days 1 through 5, followed by no copay for days 6 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H4461-060 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $125 copay for outpatient hospital services and a $75 copay per stay for observation services. Members pay no copay or coinsurance for ambulatory surgical center and blood services, while outpatient substance abuse sessions require a $20 to $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H4461-060 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Humana Gold Plus H4461-060 (HMO) plan, featuring a $335 copay and no coinsurance for both ground and air ambulance transfers. Transportation benefits are partially covered, providing up to 60 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by the Humana Gold Plus H4461-060 (HMO) plan 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 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 H4461-060 (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits for a $15 copay and no coinsurance. Physical, occupational, and speech therapy services require a $20 to $40 copay and no coinsurance, podiatry is not covered, and some chiropractic services are covered but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H4461-060 (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering a memory fitness program with no copay and no coinsurance, while excluding services like health education, in-home safety assessments, and weight management.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H4461-060 (HMO) with a $15 copay and no coinsurance for Medicare-covered exams, while routine exams, fittings, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with a $499 to $799 copay and no coinsurance for up to two aids per year, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Humana Gold Plus H4461-060 (HMO) provides partial coverage for vision services, offering one routine eye exam per year and select eyewear up to a $300 annual limit with no copay, no coinsurance, and no deductible. Other eye exam services, separate eyeglass lenses, separate frames, and upgrades are not covered by the plan.
Dental Services See details
Humana Gold Plus H4461-060 (HMO) dental services are partially covered, providing up to a $2,000 annual maximum with no copay and no coinsurance for most preventive and comprehensive services, though Medicare-covered dental requires a $15 copay and no coinsurance. Fluoride treatments, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4461-060 (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Related Medicare Part B drugs, including chemotherapy and radiation, carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H4461-060 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive coverage for these services.
Medical Equipment See details
Humana Gold Plus H4461-060 (HMO) covers durable medical equipment and prosthetic devices with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay and 10% to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H4461-060 (HMO) with prior authorization and referrals required. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic tests with a copay between $0 and $65. Radiological services include outpatient X-rays with no copay, diagnostic radiology with copays starting at $0, and therapeutic radiology requiring a minimum 20% coinsurance and a $15 copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H4461-060 (HMO) with no copay and no coinsurance. Members must obtain a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus H4461-060 (HMO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization and referrals are required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-060 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, charging a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required for this benefit, though a prior three-day inpatient hospital stay is not.
Other Services See details
Humana Gold Plus H4461-060 (HMO) provides partial coverage for other services, including acupuncture with a $15 copay and no coinsurance for up to 20 treatments per year. Over-the-counter items and chronic illness meal benefits are covered with no copay and no coinsurance, though other miscellaneous services and dual-eligible SNP benefits are not covered.
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