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Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in Indiana. The overall rating for this plan is not yet available for 2026.
It's important to know that Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP).
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 SNP-DE H4939-003 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.40. 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 $9250.00 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:
Sign up for Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP)
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Drug Coverage
The Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. If you use standard mail order, Tier 1 drugs carry a $10 to $30 copay, while Tier 2 drugs carry a $20 to $60 copay depending on the supply. For Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance applies to standard pharmacies, preferred mail order, and standard mail order services. The coinsurance covers up to a three-month supply for Tiers 3 and 4, and a one-month supply for Tier 5 specialty medications.
Additional Benefits
The Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) offers comprehensive medical coverage with no copay and a 20% coinsurance for primary care, specialist visits, and outpatient hospital services. Preventive care and home health services are covered with no copay and no coinsurance. For hospitalizations, members pay no coinsurance but are responsible for copays of $2,230 for inpatient acute stays and $2,080 for psychiatric stays. Additionally, the plan features supplemental benefits, including preventive and comprehensive dental care up to $4,000 annually with no copay and no coinsurance. Members also receive coverage for prescription hearing aids, over-the-counter items, and up to 24 plan-approved one-way transportation trips per year with no copays or coinsurance. Routine vision exams and select eyewear are covered with no copay and a 20% coinsurance up to a $500 annual limit.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring prior authorization and copays of $2,230 and $2,080 per stay, respectively. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for these covered services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and a 20% coinsurance up to $40, while worldwide emergency, urgent, and transportation services require a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers primary care, specialist, telehealth, therapy, psychiatric, and mental health services with no copay and a 20% coinsurance. Podiatry services are not covered, and while some chiropractic services are covered, routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. However, the benefit is only partially covered as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) with no deductible, including one annual routine exam with a 20% coinsurance and no copay, and unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two aids every three years, excluding inner ear, outer ear, and over the ear types. Over-the-counter (OTC) hearing aids are also covered with no copay or coinsurance.
Vision Services See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) partially covers vision services with no deductible, offering routine eye exams and select eyewear with no copays and a 20% coinsurance up to a $500 annual limit. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers Medicare dental services with no copay and a 20% coinsurance, alongside partially covered preventive and comprehensive dental benefits up to a $4,000 yearly limit with no copay and no coinsurance. Specific services such as fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers Home Infusion bundled Services with prior authorization and step therapy requirements. Part B insulin drugs require a $35 copay, other Part B drugs require no copay, and chemotherapy drugs require a copay, with all carrying coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required before receiving these services.
Medical Equipment See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with no copays and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers diagnostic and radiological services, with prior authorization required. Diagnostic tests, procedures, and lab services have no copay and 20% coinsurance, while outpatient X-rays carry a $50 copay and 20% coinsurance, and diagnostic radiological services require a $175 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. While some services are covered, specific options like cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H4939-003 (HMO-POS D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not 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 SNP-DE H4939-003 (HMO-POS D-SNP), featuring acupuncture with no copay and 20% coinsurance up to 20 treatments per year. Over-the-counter items and meal benefits are also covered with no copay and no coinsurance, though prior authorization is required for meals and acupuncture, and some other miscellaneous services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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