Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP)
Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H4007-018
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H4007-018
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Puerto Rico Counties Served
Basic Costs and Coverage
Coverage | Cost |
---|---|
Monthly Deductible | $0 |
Out of Pocket Max |
In-Network: $3400 Out-of-Network: N/A |
Initial Coverage Limit | $2000 |
Catastrophic Coverage Limit | $2,000 |
Primary Care Doctor Visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0 |
Specialty Doctor Visit | In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0 Referral Required for Doctor Specialty Visit |
Inpatient Hospital Care | In-Network: Acute Hospital Services: Copayment for Acute Hospital Services per Stay $0 Prior Authorization Required for Acute Hospital Services Prior authorization required |
Urgent Care | Copayment for Urgent Care $0 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0 |
Emergency Room Visit | Copayment for Emergency Care $0 Worldwide Coverage: Copayment for Worldwide Emergency Coverage $0 Copayment for Worldwide Emergency Transportation $0 |
Ambulance Transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $0 Air Ambulance: Copayment for Air Ambulance Services $0 Prior Authorization Required for Air Ambulance Prior authorization required |
Health Care Services and Medical Supplies
Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
Coverage | Cost |
---|---|
Chiropractic Services | In-Network: Copayment for Medicare-covered Chiropractic Services $0 Copayment for Routine Care $0
|
Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Copayment for Medicare-covered Diabetic Supplies $0 Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0 |
Durable Medical Eqipment (DME) | In-Network: Copayment for Medicare-covered Durable Medical Equipment $0 Prior Authorization Required for Durable Medical Equipment Prior authorization required |
Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 Copayment for Medicare-covered Lab Services $0 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services Referral Required for Outpatient Diag Procs/Tests/Lab Services Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0 Copayment for Medicare-covered Therapeutic Radiological Services $0 Copayment for Medicare-covered X-Ray Services $0 Prior authorization required |
Home Health Care | In-Network: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services Prior authorization required |
Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $0 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required |
Mental Health Outpatient Care | In-Network: Copayment for Medicare-covered Individual Sessions $0 Copayment for Medicare-covered Group Sessions $0 |
Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 Prior Authorization Required for Outpatient Hospital Services Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $0 Prior Authorization Required for Outpatient Observation Services Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 Prior Authorization Required for Ambulatory Surgical Center Services Prior authorization required |
Outpatient Substance Abuse Care | In-Network: Copayment for Medicare-covered Individual Sessions $0 Copayment for Medicare-covered Group Sessions $0 |
Over-the-counter (OTC) Items | In-Network: Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0 The plan will provide 1 blood pressure monitoring unit every 5 years for members who meet the medical criteria. |
Podiatry Services | In-Network: Copayment for Medicare-Covered Podiatry Services $0 |
Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: Copayment for Skilled Nursing Facility Services per Stay $0 Prior Authorization Required for Skilled Nursing Facility Services Prior authorization required |
Dental Benefits
The following dental services are covered from in-network providers.
Coverage | Cost |
---|---|
Dental Care | 0% coinsurance for bitewing x-rays up to 1 set(s) per year. 0% coinsurance for periodontal surgery up to 1 per quadrant every 3 years. 0% coinsurance for amalgam or composite filling up to 1 per tooth every 3 years. 0% coinsurance for comprehensive oral exam, cone beam CT imaging, panoramic film up to 1 every 3 years. 0% coinsurance for crown, implant supported prosthetics up to 1 per tooth every 5 years. 0% coinsurance for bridges, complete dentures, complete or partial denture reline, partial dentures up to 1 every 5 years. 0% coinsurance for implant services, other restorative services - core buildup and prefabricated post and core up to 1 per tooth per lifetime. 0% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant per year. 0% coinsurance for periodontal debridement up to 1 per year. 0% coinsurance for pulp vitality test up to 2 per quadrant per year. 0% coinsurance for periodic oral exam, periodontal maintenance, prophylaxis (cleaning) up to 2 per year. 0% coinsurance for complete or partial denture repair up to 3 per year. 0% coinsurance for intraoral x-rays up to 6 per year. 0% coinsurance for adjustments to dentures, extractions, root canal up to unlimited per year. $2,500 maximum benefit coverage amount per year for adjustments to dentures, bridges, complete dentures, complete or partial denture reline, complete or partial denture repair, crown, implant services, implant supported prosthetics, other restorative services - core buildup and prefabricated post and core, partial dentures comprehensive benefits. |
Vision Benefits
The following vision services are covered from in-network providers.
Coverage | Cost |
---|---|
Vision Benefits | In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0 Copayment for Routine Eye Exams $0
Eyewear: Copayment for Medicare-Covered Benefits $0 Copayment for Contact Lenses $0 Copayment for Eyeglasses (lenses and frames) $0 Maximum Plan Benefit of $600 every year |
Hearing Benefits
The following hearing services are covered from in-network providers.
Coverage | Cost |
---|---|
Hearing Benefits | In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $0 Copayment for Routine Hearing Exams $0
Hearing Aids: Maximum Plan Allowance of $1,000 every year |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
Coverage | Cost |
---|---|
Preventive Services and Health/Wellness Education Programs | In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
Yearly "Wellness" visit |