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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 2026, 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 2026.
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 $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 $400.00 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 $3125.00 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) prescription drug plan features an annual drug deductible of $400. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and through preferred mail order, while standard mail order costs up to $30 for a three-month supply. Tier 2 generic medications are also highly affordable, featuring no copay for a three-month supply via preferred mail order and a low $5 copay for a one-month supply at standard pharmacies. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with savings available on three-month supplies through preferred mail order for $131. Higher-tier medications transition from flat copays to coinsurance, with Tier 4 non-preferred drugs requiring a 48% coinsurance. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply across all pharmacy and mail order options.
Additional Benefits
The Humana Gold Plus H4623-001 (HMO-POS) offers comprehensive healthcare coverage with predictable out-of-pocket costs. Members benefit from no copay for primary care visits, preventive services, and home health care, while specialist visits and physical therapy require a $35 copay. For hospital care, inpatient stays carry a $275 daily copay for the first six days with no copay thereafter, and emergency room visits have a $150 copay. This plan also includes essential supplemental benefits, featuring no copay for routine hearing and vision exams, alongside a $100 annual allowance for eyewear and up to $500 in dental preventive services. Prescription hearing aids require a copay between $699 and $999, and restorative dental services require a 30% to 40% coinsurance. Additionally, durable medical equipment is covered with a 20% coinsurance, and members can access over-the-counter items and chronic illness meal benefits with no copay.
Inpatient Hospital See details
Humana Gold Plus H4623-001 (HMO-POS) covers inpatient hospital care with no coinsurance, requiring a $275 daily copay for days 1 to 6 and no copay for days 7 and beyond. This benefit is partially covered, as non-Medicare-covered stays, room upgrades, and additional psychiatric hospital days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H4623-001 (HMO-POS) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require no copay to a $300 copay, observation services have a $275 copay per stay, and outpatient substance abuse sessions carry a $30 to $35 copay.
Partial Hospitalization See details
Humana Gold Plus H4623-001 (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H4623-001 (HMO-POS) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are not covered under this plan.
Emergency Services See details
Humana Gold Plus H4623-001 (HMO-POS) covers emergency services with a $150 copay and no coinsurance, with the copay 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
Humana Gold Plus H4623-001 (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $35 copay and no coinsurance. Mental health and psychiatric services feature a $30 copay with no coinsurance, whereas podiatry and routine chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H4623-001 (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. However, additional preventive benefits are only partially covered, excluding services such as health education, in-home safety assessments, nutritional therapy, and weight management programs.
Hearing Services See details
Humana Gold Plus H4623-001 (HMO-POS) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices per year, excluding inner ear, outer ear, and over the ear models. Over-the-counter hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H4623-001 (HMO-POS) partially covers vision services with no deductibles or coinsurance, offering one annual routine eye exam and up to $100 yearly for eyeglasses or contact lenses with no copay. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4623-001 (HMO-POS) dental services are partially covered, offering a $500 annual maximum with no copay and no coinsurance for preventive care, while restorative and prosthodontic services require no copay and 30% to 40% coinsurance. Medicare-covered dental services carry a $35 copay and no coinsurance, but fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H4623-001 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs are covered with no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus H4623-001 (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H4623-001 (HMO-POS) with prior authorization, featuring a 20% coinsurance and no copay for durable medical equipment and prosthetic devices. 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 H4623-001 (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and outpatient x-rays have no copay, while diagnostic procedures range from a $0 to $90 copay, and therapeutic radiological services require a minimum copay of $35.
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 prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H4623-001 (HMO-POS) covers some cardiac rehabilitation services with no coinsurance and prior authorization required, though several key options are not covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan, while other covered services have copayments ranging from no copay up to $35.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H4623-001 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copayment of $20 for days 1 to 20 and $218 for days 21 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H4623-001 (HMO-POS) covers acupuncture with a $35 copay and no 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, though prior authorization is required for acupuncture and meal services.
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