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Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in San Antonio, Corpus Christi, RGV, El Paso Metro. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP).
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 SNP-DE H4461-070 (HMO D-SNP), 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $265.00 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 $9250.00 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:
Sign up for Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP)
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Drug Coverage
The Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $265. For Tier 1 preferred generics and Tier 2 generics, beneficiaries enjoy no copay when using standard retail pharmacies or preferred mail-order services. If you opt for standard mail order, generic drug copays range from $10 to $20 for a one-month supply. Tier 3 preferred brands and Tier 4 non-preferred drugs both require a 25% coinsurance payment across standard retail and mail-order channels. Specialty drugs in Tier 5 carry a 30% coinsurance for a one-month supply through all available pharmacy network options.
Additional Benefits
The Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) offers comprehensive medical coverage with no copay and no coinsurance for preventive care, home health services, and routine transportation up to sixty trips per year. For inpatient hospital stays, members pay a set copay of $2,230 per stay for acute care with no coinsurance. Most outpatient services, primary care, specialist visits, and medical equipment are covered with no copay and a 20% coinsurance. This plan also features valuable supplemental benefits, including dental care up to $3,000 annually and routine eyewear up to $300 yearly, both with no copay or coinsurance. Hearing exams, hearing aids, and over-the-counter items are also covered with no copay and minimal to no coinsurance. Emergency care is accessible with a $115 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) covers outpatient services, including hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and 20% coinsurance. Prior authorization and referrals are required for most of these services, though the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization services are covered under the Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) covers emergency ground and air ambulance services with a 20% coinsurance and no copay. Routine transportation is partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, though trips to non-approved health locations are not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits are offered by the Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) with no copay and a 20% coinsurance for most services, including specialist visits, physical therapy, and mental health care. Podiatry services and routine chiropractic care are not covered under this plan.
Preventive Services See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copays and no coinsurance. However, additional preventive services such as fitness benefits, health education, in-home safety assessments, and nutritional counseling are not covered.
Hearing Services See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) covers hearing services with no deductible, offering routine hearing exams with a 20% coinsurance and no copay, alongside fitting evaluations and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, though inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) offers partially covered vision services, including one annual routine eye exam with no copay and 20% coinsurance, and up to $300 yearly for eyewear with no copay or coinsurance. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) offers partially covered dental services with no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $3,000 yearly limit. While exams, cleanings, and restorative care are covered, fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) covers home infusion bundled services with prior authorization, where Medicare Part B chemotherapy and radiation drugs require a copay and coinsurance ranging from no coinsurance to 20%. Other Medicare Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%, while covered Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, is covered by Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP), requiring prior authorization and referrals. Diagnostic procedures and tests require a copay, while lab services and all radiological services have no copay, with all covered services subject to a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) plan with no copay and no coinsurance. Please note that both prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) plan are covered with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, specific sub-services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services for the Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) are partially covered, featuring acupuncture with no copay and a 20% coinsurance for up to 20 treatments per year. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, while highly integrated services for dual eligible SNPs are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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