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Humana Gold Plus H4461-078 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-078 (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 H4461-078 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-078 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Alabama. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H4461-078 (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 H4461-078 (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 H4461-078 (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 $590.00 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 $6100.00 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 H4461-078 (HMO) plan features an Enhanced Alternative drug benefit with a $590.00 annual prescription drug deductible. During the initial coverage phase, you will pay a $5.00 copay for Tier 1 preferred generics at standard pharmacies and preferred mail delivery, while Tier 2 standard generics require a $47.00 copay. Brand-name medications in Tier 3 and Tier 4 require a 48% and 26% coinsurance, respectively. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will have no copay for covered Medicare Part D drugs. Additionally, individuals who qualify for the low-income subsidy will pay no premium for Part D coverage.
Additional Benefits
The Humana Gold Plus H4461-078 (HMO) plan delivers affordable coverage for essential medical needs, featuring no copay for primary care visits and a $20 copay for specialist appointments. For inpatient hospital care, you will pay a $295 daily copay for days one through eight, followed by no copay for additional days. Emergency room visits carry a $130 copay, which is waived if you are admitted within 24 hours, while routine lab work and outpatient X-rays are covered with no copay. This plan also provides robust supplemental care, including routine vision and hearing exams with no copay, a $250 annual eyewear allowance, and up to a $3,000 annual limit on select dental services with no copay. Home health services are fully covered with no copay, and skilled nursing facility stays require no copay for the first 20 days. Durable medical equipment and dialysis services are covered with a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H4461-078 (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for stays. For acute care, you pay a $295 daily copay for days 1-8 and no copay for days 9-999, but upgrades and non-Medicare-covered stays are not covered. Psychiatric stays require a $272 daily copay for days 1-8 and no copay for days 9-90, though additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H4461-078 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $230 copay for outpatient hospital services and a $295 copay per stay for observation services. There is a $35 copay for outpatient substance abuse sessions, while ambulatory surgical center and outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus H4461-078 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Humana Gold Plus H4461-078 (HMO), with prior authorization required for all ambulance services. Ground ambulance services require a $335 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay. Transportation services to both plan-approved and any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H4461-078 (HMO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H4461-078 (HMO) offers primary care physician services with no copay, while other services like specialist visits and physical therapy require a $20 copay. This benefit is partially covered, as podiatry services and routine chiropractic care are not covered under the plan.
Preventive Services See details
Humana Gold Plus H4461-078 (HMO) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are only partially covered, as sub-services like health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H4461-078 (HMO) partially covers hearing services with no coinsurance, offering routine hearing exams and fitting evaluations for no copay, Medicare-covered exams for a $20 copay, and general prescription hearing aids for a $0 to $299 copay. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Humana Gold Plus H4461-078 (HMO) covers vision services with no coinsurance, offering routine eye exams with no copay (and other eye exams for a $0 to $20 copay) alongside a $250 annual eyewear allowance with no copay. This benefit is partially covered, as standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4461-078 (HMO) partially covers dental services, offering Medicare-covered dental services for a $20 copay and no coinsurance, and other covered dental services with no copay or coinsurance up to a $3,000 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4461-078 (HMO) covers Home Infusion bundled Services with prior authorization, requiring a $35 copay and no coinsurance to 20% coinsurance for Part B insulin. Chemotherapy, radiation, and other covered Part B drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H4461-078 (HMO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization is required for this benefit.
Medical Equipment See details
Humana Gold Plus H4461-078 (HMO) covers durable medical equipment and prosthetic devices with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts carry a $10 copay. Prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-078 (HMO) covers diagnostic and radiological services, which require prior authorization. Lab services and outpatient X-rays are provided with no copay and no coinsurance, while other diagnostic tests cost between $0 and $50 with no coinsurance. Diagnostic radiological services require a copay of up to $335 with no coinsurance, and therapeutic radiological services require a $20 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H4461-078 (HMO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H4461-078 (HMO) plan, meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered under the Humana Gold Plus H4461-078 (HMO) plan, as additional days beyond the Medicare-covered limit are not covered. Covered services require prior authorization and feature no copay or coinsurance for days 1 through 20, followed by a $218 daily copay and no coinsurance for days 21 through 100.
Other Services See details
Humana Gold Plus H4461-078 (HMO) partially covers other services, offering acupuncture for a $20 copay and no coinsurance for up to 20 treatments per year, as well as meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items and dual eligible SNPs are not covered, and prior authorization is required for the covered services.
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