Humana Gold Plus H4461-030 (HMO) H4461-030 is a 2023 Medicare Advantage Plan or Part-C by Humana available to residents in Tennessee. This plan includes extra prescription drug (Part-D) coverage. Humana Humana Gold Plus H4461-030 (HMO) has a monthly premium of $95.00 and has an in-network maximum out-of-pocket limit of $2,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $2,000 out-of-pocket. This can be an extremely nice safety net.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Gold Plus H4461-030 (HMO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Tennessee.

2023 Humana Medicare Advantage Plan Overview

What type of plan is Humana Gold Plus H4461-030 (HMO)

Humana Gold Plus H4461-030 (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your primary care physician will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

How much does Humana Gold Plus H4461-030 (HMO) cost?

Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Humana charges a $95.00 consolidated premium. The Part C premium is $56.70 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Humana Gold Plus H4461-030 (HMO) has a monthly drug premium of $50.30 and a $0 drug deductible. This Humana plan offers a $50.30 Part-D Basic Premium that is Not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by Humana above and beyond the standard PDP benefits. This can include extra coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $50.30. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Humana Gap Coverage

In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers extra coverage. This Humana plan does not offer extra coverage through the gap.

Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The Humana Gold Plus H4461-030 (HMO) medicare insurance offers a $15.10 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $23.90 for 75% low-income subsidy $32.70 for 50% and $41.50 for 25%.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Humana Gold Plus H4461-030 (HMO) by Humana MOOP is $2,000. Once you spend $2,000 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

Formulary and Drug Coverage

Humana Gold Plus H4461-030 (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$0
Tier 3	NA	$47
Tier 4	NA	$97
Tier 5	NA	33%

The complete Humana Gold Plus H4461-030 (HMO) Formulary.
*Initial Coverage Phase and 30 day supply

2023 Summary of Benefits

The benefit information provided is a summary of what Humana Gold Plus H4461-030 (HMO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Humana helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)	Covered

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Contact lenses

Vision	$0 copay

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Eyeglass frames

Vision	Not covered

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Eyeglass lenses

Vision	Not covered

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Eyeglasses (frames and lenses)

Vision	$0 copay

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Other

Vision	Not covered

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Routine eye exam

Vision	$0 copay

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Upgrades

Vision	Not covered

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Transportation	Not covered
Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 100
Skilled Nursing Facility	$0 per day for days 1 through 20 $178 per day for days 21 through 100

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Occupational therapy visit

Rehabilitation services	$10 copay
Rehabilitation services	$20 copay

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Physical therapy and speech and language therapy visit

Rehabilitation services	$10 copay
Rehabilitation services	$20 copay

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Cleaning

Preventive dental	$0 copay

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Dental x-ray(s)

Preventive dental	$0 copay

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Fluoride treatment

Preventive dental	$0 copay

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Oral exam

Preventive dental	$0 copay

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Preventive care	$0 copay
Outpatient hospital coverage	$0-195 copay per visit
Outpatient hospital coverage	$0-225 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

Mental health services	$250 per stay

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Outpatient group therapy visit

Mental health services	$20 copay
Mental health services	$25 copay

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Outpatient group therapy visit with a psychiatrist

Mental health services	$20 copay
Mental health services	$25 copay

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Outpatient individual therapy visit

Mental health services	$25 copay
Mental health services	$20 copay

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Outpatient individual therapy visit with a psychiatrist

Mental health services	$20 copay
Mental health services	$25 copay

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Chemotherapy

Medicare Part B drugs	20% coinsurance

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Other Part B drugs

Medicare Part B drugs	20% coinsurance

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Diabetes supplies

Medical equipment/supplies	$0 copay or 10-20% coinsurance per item

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Durable medical equipment (e.g., wheelchairs, oxygen)

Medical equipment/supplies	20% coinsurance per item

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Prosthetics (e.g., braces, artificial limbs)

Medical equipment/supplies	20% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$2,000 In-network
Inpatient hospital coverage	$0 copay per stay

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Fitting/evaluation

Hearing	$0 copay

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Hearing aids

Hearing	$0-299 copay
Hearing	$199-499 copay

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Hearing exam

Hearing	$25 copay
Hearing	$20 copay

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Health plan deductible	$0
Ground ambulance	$300 copay
Ground ambulance	$265 copay

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Foot exams and treatment

Foot care (podiatry services)	$25 copay
Foot care (podiatry services)	$20 copay

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

Emergency care/Urgent care	$90 copay per visit (always covered)
Emergency care/Urgent care	$125 copay per visit (always covered)

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Urgent care

Emergency care/Urgent care	$25 copay per visit (always covered)
Emergency care/Urgent care	$20 copay per visit (always covered)

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Primary

Doctor visits	$0 copay

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Specialist

Doctor visits	$20 copay per visit
Doctor visits	$25 copay per visit

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Diagnostic radiology services (e.g., MRI)

Diagnostic procedures/lab services/imaging	$0-225 copay
Diagnostic procedures/lab services/imaging	$0-150 copay

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Diagnostic tests and procedures

Diagnostic procedures/lab services/imaging	$0-25 copay
Diagnostic procedures/lab services/imaging	$0-20 copay

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Lab services

Diagnostic procedures/lab services/imaging	$0-20 copay
Diagnostic procedures/lab services/imaging	$0-25 copay

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Outpatient x-rays

Diagnostic procedures/lab services/imaging	$0-25 copay
Diagnostic procedures/lab services/imaging	$0-20 copay

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Diagnostic services

Comprehensive dental	$0 copay

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Endodontics

Comprehensive dental	$0 copay

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Extractions

Comprehensive dental	$0 copay

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Non-routine services

Comprehensive dental	$0 copay

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Periodontics

Comprehensive dental	$0 copay

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Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dental	$0 copay

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Restorative services

Comprehensive dental	$0 copay

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

Humana Gold Plus H4461-030 (HMO) Reviews

Is Humana Gold Plus H4461-030 (HMO) a good plan? Humana Gold Plus H4461-030 (HMO) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Humana Gold Plus H4461 030 Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H4461-030 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for Humana

Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Humana Gold Plus H4461-030 (HMO) requires you to live in that plan’s service area. The service area is listed below:

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Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.