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Humana Gold Plus H4461-073 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-073 (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 H4461-073 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-073 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Gulf Shores. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-073 (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 H4461-073 (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 H4461-073 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $139.00. 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 $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 $1900.00 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 H4461-073 (HMO) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615. After meeting this deductible, you will enjoy no copay for Tier 1 preferred generic drugs at standard pharmacies and through preferred mail order, or a $20 copay via standard mail. For Tier 2 standard generics, you will pay a flat $47 copay across standard pharmacies, preferred mail, and standard mail. Tier 3 preferred brands require a 50% coinsurance, and Tier 4 non-preferred drugs require a 25% coinsurance. Once your annual out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy can see their Part D premium reduced from $33.20 to $5.50.
Additional Benefits
The Humana Gold Plus H4461-073 (HMO) plan offers robust coverage with no deductibles and several services featuring no copayments or coinsurance. Members enjoy no copay for inpatient hospital stays, primary care visits, and routine preventive services, while specialist visits require a low $5 copay. Outpatient services, diagnostic lab tests, and home health care also feature no copay, though emergency room visits carry a $150 copay that is waived if admitted. For supplemental care, this plan provides generous vision and dental benefits, including an annual dental limit of $4,000 and up to $350 for eyewear with no copay. While routine hearing exams and over-the-counter hearing aids have no copay, prescription devices may require a copay up to $299. Other specialized services, such as durable medical equipment and dialysis, require a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Plus H4461-073 (HMO) partially covers inpatient hospital benefits, offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Humana Gold Plus H4461-073 (HMO) covers outpatient services with no coinsurance and no deductibles. There is no copay for ambulatory surgical center, observation, and blood services, while outpatient hospital visits range from a $0 to $35 copay and substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Humana Gold Plus H4461-073 (HMO) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Humana Gold Plus H4461-073 (HMO), with ground ambulance requiring a $335 copay and no coinsurance, and air ambulance requiring a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H4461-073 (HMO) covers emergency services with a $150 copay and no coinsurance, which is 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
Primary Care benefits under the Humana Gold Plus H4461-073 (HMO) plan are partially covered with no coinsurance, as podiatry services and routine chiropractic care are not covered. Covered services feature no copay for primary care visits, a $5 copay for specialists, a $10 copay for occupational or physical therapy, and a $35 copay for mental health and psychiatric sessions.
Preventive Services See details
Humana Gold Plus H4461-073 (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes training. However, this benefit is only partially covered, as sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, telemonitoring, remote access, home safety devices, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H4461-073 (HMO) covers hearing exams with a $5 copay and no coinsurance, which includes routine exams and fitting evaluations for no copay. Prescription hearing aids are partially covered with a $0 to $299 copay and no coinsurance for up to two devices every three years, though inner ear, outer ear, and over the ear types are not covered. OTC hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H4461-073 (HMO) covers vision services with no coinsurance, offering eye exams for a $0 to $5 copay, which includes one routine exam per year with no copay. Eyewear is partially covered with no copay and no coinsurance up to a $350 annual limit for contact lenses and complete eyeglasses, though standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H4461-073 (HMO) up to a $4,000 annual limit, featuring a $5 copay for Medicare-covered dental care and no copay or coinsurance for most other preventive and comprehensive services. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4461-073 (HMO) covers home infusion bundled services subject to prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while other covered Part B chemotherapy, radiation, and miscellaneous drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H4461-073 (HMO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H4461-073 (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.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-073 (HMO) covers diagnostic and radiological services with prior authorization, offering lab and outpatient X-ray services with no copay and no coinsurance. Diagnostic procedures range from no copay to a $65 copay, and diagnostic radiology ranges from no copay to a $335 copay, both with no coinsurance. Therapeutic radiology requires a copay of up to $5 and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H4461-073 (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H4461-073 (HMO) plan. There is no coverage or cost-sharing available for any of the sub-services, including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-073 (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization, though additional days beyond the Medicare-covered limit are not covered. Covered stays require no copay and no coinsurance for days 1 to 20, and a $218 daily copay with no coinsurance for days 21 to 100.
Other Services See details
Other Services are covered by Humana Gold Plus H4461-073 (HMO), including acupuncture for a $5 copay and no coinsurance, and meal benefits and select over-the-counter items with no copay and no coinsurance. Highly integrated Dual Eligible SNP services are not covered, and some CMS OTC list drugs are also excluded from coverage.
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