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Humana Gold Plus H4461-061 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-061 (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 H4461-061 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-061 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in El Paso and Hudspeth counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-061 (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 H4461-061 (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 H4461-061 (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 $3250.00 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 H4461-061 (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for one-month and three-month supplies when using standard pharmacies or preferred mail order services. If you choose standard mail order for these generic tiers, copays range from $10 to $20 for a one-month supply. Tier 3 preferred brand drugs require a $45 copay for a one-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. For higher-tier medications, members pay a 35% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs. These structured costs help you easily estimate your monthly out-of-pocket prescription expenses under this Medicare plan.
Additional Benefits
The Humana Gold Plus H4461-061 (HMO) plan offers comprehensive medical coverage featuring no copay for primary care visits, preventive screenings, and home health services, while specialist visits require a $15 copay. For hospital care, inpatient stays carry a $95 daily copay for the first five days and no copay thereafter, and outpatient hospital services range from no copay up to a $120 copay. Emergency care is covered with a $150 copay, which is waived if admitted, while urgent care visits require a $65 copay. This plan also includes generous supplemental benefits, including dental care with no copay for most services up to a $2,000 annual limit and vision coverage with no copay for eyewear up to $300. Additionally, members enjoy routine hearing exams and over-the-counter hearing aids with no copay, along with up to 24 one-way transportation trips per year to approved locations. Other extra benefits such as acupuncture, select over-the-counter items, and post-discharge meals are also provided with no copay.
Inpatient Hospital See details
Humana Gold Plus H4461-061 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $95 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are covered with no copay.
Outpatient Services See details
Humana Gold Plus H4461-061 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $120 copay, observation services require a $95 copay per stay, and outpatient substance abuse sessions carry a $20 to $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H4461-061 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H4461-061 (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 and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H4461-061 (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 are covered with 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 H4461-061 (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Other covered services, including physical therapy, mental health, telehealth, and opioid treatment, require copays ranging from $0 to $65 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H4461-061 (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. However, this benefit is only partially covered; sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H4461-061 (HMO) covers hearing services, including routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams require a $15 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $99.00 to $399.00 for up to two devices per year, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Humana Gold Plus H4461-061 (HMO) partially covers vision services with no coinsurance or deductibles, featuring a $0 to $15 copay for eye exams and no copay for eyewear up to a $300 annual maximum. However, other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4461-061 (HMO) partially covers dental services up to a $2,000 annual maximum, with no copay and no coinsurance for most preventive and comprehensive services, and a $15 copay and no coinsurance for Medicare-covered dental. Fluoride treatment, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4461-061 (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Medicare Part B drugs, including chemotherapy and insulin, are covered with coinsurance ranging from no coinsurance to 20%, with insulin specifically requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Plus H4461-061 (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
Medical equipment benefits covered by the Humana Gold Plus H4461-061 (HMO) include durable medical equipment (DME) and prosthetic devices with a 20% coinsurance and no copay. Medical supplies are covered with a 20% coinsurance and no copay, diabetic supplies feature a 10% to 20% coinsurance and no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-061 (HMO) covers diagnostic and radiological services, with diagnostic services requiring no coinsurance, no copay for lab tests, and a copay of $0 to $95 for diagnostic procedures. Radiological services require prior authorization and referrals, featuring no copay for outpatient X-rays and a minimum $15 copay and 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H4461-061 (HMO) plan with no copay and no coinsurance. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H4461-061 (HMO) with no coinsurance, though prior authorization and referrals are required. Covered services require a $15 copay for cardiac and intensive cardiac rehabilitation, and a $20 copay for pulmonary and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H4461-061 (HMO) 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, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Humana Gold Plus H4461-061 (HMO) partially covers other services, offering acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture, which is limited to 12 treatments per year, and the meal benefit, while select OTC items are covered via reimbursement.
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