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Humana Gold Plus H4623-001 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4623-001 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H4623-001 (HMO-POS) in 2025, please refer to our full plan details page.
Humana Gold Plus H4623-001 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Southwest Missouri. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H4623-001 (HMO-POS) 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 H4623-001 (HMO-POS).
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 H4623-001 (HMO-POS), 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 $4.00. 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 $250.00 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 $3400.00 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 H4623-001 (HMO-POS) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $5 copay for preferred generic drugs at a standard pharmacy, and 48% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H4623-001 (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $275 copay for the first six days, while outpatient services have copays ranging from $0 to $300. Emergency services have a $140 copay, and primary care visits are free. The plan also includes coverage for preventive services with no copay, hearing exams with a $35 copay, and vision services with no copay for routine eye exams and eyewear. Dental services have a $35 copay for Medicare-covered services, and some services have coinsurance. Other benefits include home health services with no copay, and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-6, and no copay for days 7-90, with no coinsurance; for additional days 91-999, there is no copay or coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-6, and no copay for days 7-90, with no coinsurance. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $300, observation services with a $275 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $35 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H4623-001 (HMO-POS) plan. The plan has a $35 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a 20% coinsurance; Transportation Services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by this plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services has a $65 copay; all have no coinsurance.
Primary Care See details
Under the Humana Gold Plus H4623-001 (HMO-POS) plan, Primary Care Physician Services have no copay, Chiropractic Services have a $20 copay, and Occupational Therapy Services have a $35 copay. Physician Specialist Services have a $35 copay, while Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $35 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $35 copay, and Additional Telehealth Benefits have a copay between $0 and $65. However, Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Humana Gold Plus H4623-001 (HMO-POS) plan covers preventive services including an annual physical exam with no copay. Additionally, it covers other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay.
Hearing Services See details
The Humana Gold Plus H4623-001 (HMO-POS) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 depending on the type of hearing aid, while OTC hearing aids and prescription hearing aids for inner, outer, and over the ear are not covered.
Vision Services See details
The Humana Gold Plus H4623-001 (HMO-POS) plan covers vision services, including routine eye exams with no copay, and eyewear with no copay and a combined maximum benefit of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H4623-001 (HMO-POS) plan covers Medicare Dental Services with a $35 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services, all with no copay; however, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative Services and Prosthodontics, fixed have 30%-40% coinsurance. Prosthodontics, removable has 30% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H4623-001 (HMO-POS) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H4623-001 (HMO-POS) plan. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and prior authorization required, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a coinsurance between 10-20% and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $90, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $350, Therapeutic Radiological Services have a copay between $35 and $40, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H4623-001 (HMO-POS) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Humana Gold Plus H4623-001 (HMO-POS) plan, but specific services like Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, and the copay is $20 for days 1-20 and $203 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for Humana Gold Plus H4623-001 (HMO-POS) covers acupuncture with a $35 copay, and a meal benefit with no copay; all other listed services are not covered. Acupuncture is limited to 20 treatments per year and requires prior authorization.
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