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Humana Gold Plus H4461-062 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-062 (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 H4461-062 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-062 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Northeast Texas. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-062 (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 H4461-062 (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 H4461-062 (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 $2.00. 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 $4225.00 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 H4461-062 (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and preferred mail order. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a 1-month supply at standard pharmacies and featuring no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at standard pharmacies or via preferred mail order. Tier 4 non-preferred drugs carry a 48% coinsurance across standard pharmacies, preferred mail order, and standard mail order. For Tier 5 specialty drugs, members are responsible for a 25% coinsurance for a 1-month supply regardless of the pharmacy type.
Additional Benefits
The Humana Gold Plus H4461-062 (HMO) plan offers medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist office visits require a low $15 copay, while inpatient hospital stays have a $295 daily copay for the first five days and no copay for days six through ninety. Outpatient hospital care features copays ranging from no copay up to $275, with no coinsurance required. Supplemental benefits include dental care covered up to a $3,000 annual limit, with no copay for preventive services and a $15 copay for Medicare-covered dental. Vision and hearing services feature no deductible and no copay for routine eye exams, routine hearing exams, and over-the-counter hearing aids. Members also enjoy no copay and no coinsurance for acupuncture, meal benefits, and over-the-counter items.
Inpatient Hospital See details
Humana Gold Plus H4461-062 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute 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 H4461-062 (HMO) covers outpatient services with no coinsurance, requiring copays of $0 to $275 for outpatient hospital services and $295 per stay for observation services. Outpatient substance abuse sessions carry a $20 to $35 copay, while ambulatory surgical center and outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H4461-062 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus H4461-062 (HMO) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. Some transportation services are covered, but transportation to plan-approved locations or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered under Humana Gold Plus H4461-062 (HMO) with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $50 copay, and worldwide emergency, urgent, and transportation services are covered with a $130 copay, with no coinsurance required for any of these benefits.
Primary Care See details
Humana Gold Plus H4461-062 (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Therapy, mental health, and telehealth services are covered with copays ranging from $0 to $50 and no coinsurance, while podiatry and routine chiropractic care are not covered.
Preventive Services See details
Humana Gold Plus H4461-062 (HMO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, and a memory fitness benefit, all with no copay and no coinsurance. Additional preventive benefits are partially covered, but services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge 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 counseling, enhanced disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H4461-062 (HMO) offers hearing services with no deductible, providing Medicare-covered exams for a $15 copay and no coinsurance, alongside routine exams, fitting evaluations, and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $199 and $499 for up to two devices per year, excluding inner ear, outer ear, and over-the-ear hearing aids.
Vision Services See details
Humana Gold Plus H4461-062 (HMO) vision services are partially covered with no deductible, no copay, and no coinsurance for one routine annual eye exam and select eyewear up to a $300 yearly limit, though prior authorization is required. Other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Dental services under the Humana Gold Plus H4461-062 (HMO) are partially covered up to a $3,000 annual limit, requiring a $15 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4461-062 (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while covered Part B insulin has a $35 copay and a coinsurance from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus H4461-062 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H4461-062 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 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 and coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-062 (HMO) covers diagnostic and radiological services, offering diagnostic lab services and outpatient X-rays with no copay. Other diagnostic procedures and tests have no coinsurance and copays ranging from $0 to $100, while therapeutic radiological services require a minimum $15 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus H4461-062 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H4461-062 (HMO) with no copay and 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.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-062 (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not needed, additional days beyond the standard Medicare benefit period are not covered.
Other Services See details
Humana Gold Plus H4461-062 (HMO) partially covers other services, providing acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while certain other unspecified services and dual-eligible SNP benefits are not covered.
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