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Humana Gold Plus H4007-021 (HMO)

H4007 - 021 - 0
4 out of 5 stars (4 / 5)

humana medicare provider logo

Humana Gold Plus H4007-021 (HMO) is a Medicare Advantage Plan by Humana.

This page features plan details for 2025 Humana Gold Plus H4007-021 (HMO) H4007 – 021 – 0 available in Puerto Rico Island Wide.

Locations

Humana Gold Plus H4007-021 (HMO) is offered in the following locations.

Adjuntas County, Puerto Rico
Aguada County, Puerto Rico
Aguadilla County, Puerto Rico

Click to see more locations

Plan Overview

Humana Gold Plus H4007-021 (HMO) offers the following coverage and cost-sharing.

Insurer:Humana
Health Plan Deductible:–
MOOP:$5,000.00 in-network
Drugs Covered:Yes

Ready to sign up for Humana Gold Plus H4007-021 (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Humana Gold Plus H4007-021 (HMO) qualifies for a monthly Medicare Give Back Benefit of $48.00.

Premium Reduction:$48.00

Premium Breakdown

Humana Gold Plus H4007-021 (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $48.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Humana Gold Plus H4007-021 (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Humana Gold Plus H4007-021 (HMO) also provides the following benefits.

Cardiac and Pulmonary Rehabilitation Services

Additional Cardiac Rehabilitation Services

  • Copay: $0.00

Additional Pulmonary Rehabilitation Services

  • Copay: $0.00

Additional Intensive Cardiac Rehabilitation Services

  • Copay: $5.00

Additional Supervised Exercise Therapy for Peripheral Artery Disease

  • Copay: $0.00
  • Authorization Required: Yes
  • Referral Required: No

Durable Medical Equipment, Prosthetics/Orthotics, and Medical Supplies

Prosthetics/Medical Supplies

  • Copay: $0.00

Durable Medical Equipment (DME)

  • Authorization Required: Yes
  • Preferred Vendors: No

Prosthetics/Orthotics – Orthotic Devices

  • Copay: $0.00

Prosthetics/Orthotics – Orthotic Devices

  • Copay: $0.00

Medical Supplies – Medical/Surgical Supplies

  • Copay: $0.00

Medical Supplies – Medical/Surgical Supplies

  • Copay: $0.00
  • Authorization Required: No
  • Specified Manufacturers: Yes
  • Limits Apply: Yes

Emergency and Urgent Care Services

Urgently Needed Services

  • Copay: $75.00
  • Enhanced Benefits: Worldwide Emergency Coverage; Worldwide Urgent Coverage; Worldwide Emergency Transportation
  • Waivers if Admitted: Yes

Worldwide Emergency Transportation

  • Copay: $75.00

Eye Exams and Eye Wear Services

Eye Exams

  • Enhanced Benefits: Routine Eye Exams

Routine Eye Exams

  • Limits Apply: No

Eyewear

  • Copay: $0.00
  • Authorization Required: Yes
  • Referral Required: No
  • Enhanced Benefits: Contact lenses; Eyeglasses (lenses and frames)

Contact Lenses

  • Limits Apply: Yes

Eyeglasses (Lenses and Frames)

  • Copay: $0.00
  • Limits Apply: Yes

Health Care Professional Services

Opioid Treatment Program Services

  • Copay: $0.00

Chiropractic Services

  • Copay: $0.00
  • Authorization Required: No
  • Referral Required: Yes

Psychiatric Services – Inpatient Care

  • Copay: $0.00

Psychiatric Services – Outpatient Care

  • Copay: $0.00

PT and SP Services

  • Copay: $0.00

Hearing Exams and Hearing Aids Services

Hearing Exams

  • Enhanced Benefits: Routine Hearing Exams; Fitting/Evaluation for Hearing Aid

Routine Hearing Exams

  • Limits Apply: No

Fitting/Evaluation for Hearing Aid

  • Limits Apply: No

Hearing Aids

  • Copay: $0.00
  • Authorization Required: No
  • Referral Required: No
  • Enhanced Benefits: Hearing Aids (all types)

Hearing Aids (All Types)

  • Copay: $0.00
  • Limits Apply: No

Home Health Services

Home Health Services

  • Copay: $0.00

Home Health Services

  • Authorization Required: Yes
  • Referral Required: No

Inpatient Hospital Acute Services

Inpatient Hospital-Acute

  • Enhanced Benefits: Additional Days

Inpatient Acute Additional Days

  • Limits Apply: Yes

Inpatient Hospital-Acute

  • Authorization Required: Yes
  • Referral Required: No

Inpatient Hospital Psychiatric Services

Inpatient Hospital-Psychiatric

  • Authorization Required: Yes
  • Referral Required: No

Medicare Part B Prescription Drugs

Medicare Part B Drugs – Tier 2

  • Coinsurance: 0% – 20%

Medicare Part B Drugs – Tier 3

  • Coinsurance: 0% – 20%

Medicare Part B Drugs – Tier 1

  • Coinsurance: 0% – 20%
  • Authorization Required: Yes

Non-Primarily Health Related Benefits for the Chronically Ill

General Supports for Living

  • Authorization Required: No
  • Referral Required: No

Transportation for Non-Medical Needs

  • Limits Apply: Yes

Out-of-Network Data for PPO Plans

Outpatient Blood, Acupuncture, and Other Services

Outpatient Clinical, Diagnostic, and Therapeutic Radiology Services

Outpatient Diagnostic Procedures/Tests

  • Copay: $0.00 – $20.00

Outpatient Lab Services

  • Copay: $0.00
  • Authorization Required: Yes
  • Referral Required: Yes

Outpatient Therapeutic Radiology

  • Coinsurance: 20%

Outpatient Diagnostic Radiology

  • Copay: $0.00 – $50.00

Outpatient X-Ray Services

  • Copay: $0.00 – $10.00
  • Referral Required: No

Outpatient Hospital, ASC, Substance Abuse, and Cardiac Rehabilitation Services

Outpatient Hospital Services – General

  • Copay: $0.00 – $50.00

Outpatient Hospital Services – Observation

  • Copay: $50.00
  • Authorization Required: Yes
  • Referral Required: No

Outpatient Blood Services – Type 1

  • Copay: $0.00 – $20.00

Outpatient Blood Services – Type 2

  • Copay: $0.00 – $20.00
  • Authorization Required: No

Outpatient Blood Services

  • Copay: $0.00

Partial Hospitalization Services

Partial Hospitalization

  • Copay: $0.00
  • Authorization Required: Yes
  • Referral Required: No

Preventive Services (Health Education, Immunizations, Routine Physicals, Pap/Pelvic Exams)

Kidney Disease Education Services

  • Authorization Required: No
  • Referral Required: No

Other Medicare-covered Preventive Services

  • Copay: $0.00

Other Defined Supplemental Benefits

  • Enhanced Benefits: 14c4: Fitness Benefit*;14c8: Home and Bathroom Safety Devices and Modifications*;

Home and Bathroom Safety Devices and Modifications

  • Copay: $0.00
  • Authorization Required: Yes

Diabetes Self-Management Training – Level 1

  • Copay: $0.00

Diabetes Self-Management Training – Level 2

  • Copay: $0.00

Diabetes Self-Management Training – Level 3

  • Copay: $0.00

Diabetes Self-Management Training – Level 4

  • Copay: $0.00

Diabetes Self-Management Training – Level 5

  • Copay: $0.00
  • Authorization Required: No
  • Referral Required: No

Renal Dialysis Services

Dialysis Services

  • Coinsurance: 20%
  • Authorization Required: No
  • Referral Required: No

Skilled Nursing Facility (SNF) Services

SNF Medicare-covered stay

  • Authorization Required: Yes
  • Referral Required: No

Supplemental Benefits Preventive Services

Other Defined Supplemental Benefits

  • Enhanced Benefits: 14c8: Home and Bathroom Safety Devices and Modifications*;14c11: Personal Emergency Response System (PERS);

Personal Emergency Response System (PERS)

  • Authorization Required: No
  • Referral Required: No

Ready to sign up for Humana Gold Plus H4007-021 (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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