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Humana Gold Plus H4461-079 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4461-079 (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 H4461-079 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H4461-079 (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 H4461-079 (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 H4461-079 (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 H4461-079 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.00. 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 $4450.00 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 H4461-079 (HMO) plan features an enhanced alternative drug benefit with a $615 annual prescription drug deductible. Individuals qualifying for the low-income subsidy can see their Part D premium reduced to $20. Under the initial coverage phase, Tier 1 preferred generic drugs require no copay at standard pharmacies or preferred mail order, while Tier 2 standard generics carry a $47 copay. Tier 3 preferred brand drugs require a 50% coinsurance, and Tier 4 non-preferred drugs require a 25% coinsurance across standard pharmacies and mail delivery. These initial coverage costs apply until your yearly out-of-pocket drug costs reach $2,100. Once this threshold is met, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus H4461-079 (HMO) plan offers comprehensive coverage for core medical needs, featuring no copay and no coinsurance for primary care physician visits and annual physicals. Inpatient hospital stays require a $70 daily copay for days 1 through 11, with no copay for days 12 and beyond. Additionally, emergency room visits require a $130 copay, which is waived upon hospital admission, while specialist visits require a $15 copay. For ancillary care, this plan provides dental services with no copay up to a $4,000 annual limit, and vision services featuring eye exams and covered eyewear up to a $300 annual limit with no copay. Routine hearing exams have no copay, while prescription hearing aids require copays ranging from $99 to $399. Home health services, lab tests, and outpatient X-rays are covered with no copay, though durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H4461-079 (HMO) provides partially covered inpatient hospital benefits, featuring a $70 daily copay for days 1 through 11, no copay for days 12 and beyond, and no coinsurance. Upgrades for acute stays, additional days for psychiatric stays, and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Humana Gold Plus H4461-079 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, a $70 copay per stay for observation services, and a $35 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay ranging from $0 to $100, and prior authorization is required for most services.
Partial Hospitalization See details
Humana Gold Plus H4461-079 (HMO) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required to access these covered benefits.
Ambulance and Transportation Services See details
Humana Gold Plus H4461-079 (HMO) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and 20% coinsurance with no copay for air transport. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H4461-079 (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 each covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H4461-079 (HMO) partially covers primary care benefits, featuring primary care physician visits with no copay and specialist visits for a $15 copay, both with no coinsurance. Additional services like therapy, mental health, and telehealth are covered with copays ranging from $0 to $50 and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Humana Gold Plus H4461-079 (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, glaucoma screenings, diabetes self-management training, and in-home support. However, additional preventive services are only partially covered, excluding 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, caregiver support, tobacco cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus H4461-079 (HMO), featuring routine exams and fitting evaluations with no copay and no coinsurance, and Medicare-covered exams for a $15 copay and no coinsurance. Prescription hearing aids are also partially covered with copays between $99 and $399 and no coinsurance, while OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription models, are not covered.
Vision Services See details
Humana Gold Plus H4461-079 (HMO) partially covers vision services with no coinsurance, offering a $0 to $15 copay for eye exams and no copay for covered eyewear up to a $300 annual limit. While routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4461-079 (HMO) partially covers dental services up to a $4,000 annual limit, offering covered preventive and comprehensive services—including exams, cleanings, x-rays, restorative, endodontics, periodontics, prosthodontics, and oral surgery—with no copay and no coinsurance. Medicare-covered dental services require a $15 copay and no coinsurance, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4461-079 (HMO) covers home infusion bundled services, requiring prior authorization and featuring a $35 copay with no coinsurance to 20% coinsurance for Part B insulin. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and carry a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H4461-079 (HMO) with a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H4461-079 (HMO) covers durable medical equipment and prosthetic devices with a 20% coinsurance and no copay, and medical supplies with a 20% coinsurance. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic shoes and inserts have a $10 copay. Prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus H4461-079 (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay and no coinsurance. Diagnostic procedures require a $0 to $50 copay and diagnostic radiology ranges from a $0 to $335 copay, with no coinsurance for either, while therapeutic radiology requires a $15 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H4461-079 (HMO) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus H4461-079 (HMO) does not cover Cardiac Rehabilitation Services, as all associated sub-services, including intensive cardiac, pulmonary, and SET for PAD, are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4461-079 (HMO) partially covers Skilled Nursing Facility (SNF) care, requiring no copay or coinsurance for days 1 through 20 and a $218 daily copay with no coinsurance for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus H4461-079 (HMO), including acupuncture for a $15 copay and no coinsurance, and meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items and highly integrated dual eligible SNP services are not covered.
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