A non-government entity
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H5377-003 (HMO 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 H5377-003 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus SNP-DE H5377-003 (HMO 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 H5377-003 (HMO 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 H5377-003 (HMO 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 H5377-003 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $2.60. 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 H5377-003 (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using standard pharmacies or preferred mail order services for both 1-month and 3-month supplies. If you choose standard mail order, Tier 1 drugs carry a $10 to $30 copay, and Tier 2 drugs cost between $20 and $60 depending on the supply. For higher-tier medications, including Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you will pay a 25% coinsurance across standard pharmacies, preferred mail order, and standard mail order options. This 25% coinsurance rate applies to both 1-month and 3-month supplies for Tiers 3 and 4, and 1-month supplies for Tier 5 specialty drugs. These clear cost-sharing tiers help you easily estimate your out-of-pocket prescription costs under this Humana Medicare plan.
Additional Benefits
The Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care, though a 19% to 20% coinsurance applies to most doctor visits. For hospital stays, members pay a $2,230 copay per stay for acute inpatient care and a $250 copay plus 20% coinsurance for outpatient hospital services. Emergency care is accessible with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also features robust supplemental benefits, including up to $3,500 annually for preventive and comprehensive dental services with no copay or coinsurance. Additionally, members receive routine hearing and vision exams with no copay, a $500 annual allowance for eyewear, and up to 24 routine transportation trips per year with no copay. Over-the-counter items and meal benefits are also covered with no copay and no coinsurance, providing valuable everyday wellness support.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and while unlimited additional acute days are covered with no copay, upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) covers outpatient hospital services with a $250 copay and 20% coinsurance, and ambulatory surgical center services with a $200 copay and 20% coinsurance. Outpatient substance abuse and blood services are covered with no copay and 20% coinsurance, with prior authorization required for most outpatient services.
Partial Hospitalization See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) plan, featuring a $335 copay and no coinsurance for ground and air ambulance services. Routine transportation is partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) covers primary care, specialist, and therapy services with no copay and 19% to 20% coinsurance, though telehealth benefits may require a copay of $0 to $40 and 20% coinsurance. Chiropractic services are partially covered, offering up to 12 routine care visits per year with no copay and 20% coinsurance, but other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) offers preventive services with no copay and no coinsurance for covered benefits such as annual physical exams, glaucoma screenings, and kidney disease education. However, the benefit is only partially covered, as it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) covers routine hearing exams with no copay, a 20% coinsurance, and no deductible, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance, though inner ear, outer ear, and over the ear types are not covered, while OTC hearing aids are covered with no copay or coinsurance.
Vision Services See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) offers partially covered vision services, including one routine eye exam per year with no copay and a 20% coinsurance. Covered eyewear, such as one pair of contact lenses or eyeglasses (lenses and frames) annually, features no copay and no coinsurance up to a $500 yearly limit, though other eye exams, separate lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, plus other preventive and comprehensive services up to $3,500 annually with no copay and no coinsurance. While many services are covered, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) covers Home Infusion bundled Services, which require prior authorization and step therapy. Covered Part B insulin drugs carry a $35 copay and 0% to 20% coinsurance, while other Part B drugs have no copay and 0% to 20% coinsurance, and chemotherapy drugs require a copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services, with prior authorization required for most items. There is no copayment for these covered benefits, though a 20% coinsurance applies to durable medical equipment, prosthetic devices, medical supplies, and diabetic supplies.
Diagnostic and Radiological Services See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) covers diagnostic and radiological services with prior authorization. Diagnostic procedures require a 19% coinsurance and up to a $40 copay, lab services carry a 20% coinsurance with no copay, and outpatient x-rays require a 19% coinsurance and a $40 copay. Diagnostic radiological services carry a 20% coinsurance and a $200 copay, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization required, though in practice only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) rehabilitation services are not covered under this plan and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and prior authorization is required.
Other Services See details
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) offers partially covered other services, which include acupuncture with no copay and 20% coinsurance (up to 20 treatments per year) as well as over-the-counter items and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while highly integrated services for dual eligible SNPs and 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
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved