Humana Gold Plus H4461-083 (HMO)

CARITEN HEALTH PLAN INC. · 2027 plan year

Plan ID H4461-083-001

HMO★ 4.5 CMS Stars
MOOP (in-network)
$3,500
MOOP (combined)
—
Monthly premium
$27/mo
Part C $2 + Part D $25, before Extra Help
Prescription drugs
Included

This plan in 2026

Plan information

Contract / Plan / Segment
H4461-083-001
Medical deductible
$0 — no deductible
Part D premium
$25/mo (part of the monthly premium above)Before Extra Help, which can lower or remove it for people with limited income.
Part D deductible
$395/yr
Also owed
Your Medicare Part B premium, paid separately

Other segments for this plan:

More CARITEN HEALTH PLAN INC. plans in TN

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — Acute$195/day for days 1–5, $0 after
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — Psychiatric$195/day for days 1–5, $0 after
Worldwide Urgent Care Coverage$65

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health — Individual Sessions$35
Mental Health — Group Sessions$35
Supplemental Health BenefitsSee plan details
Mental Health Specialty ServicesSee plan details

Other

BenefitIn-network
Diagnostic Procedures & Tests$0-$100
Prosthetics & OrthoticsSee plan details
Skilled Nursing Facility (SNF)$0/day for days 1–20, $221/day for days 21–100
Cardiac Rehabilitation — Additional Sessions$15
Intensive Cardiac Rehabilitation — Additional Sessions$15
Pulmonary Rehabilitation — Additional Sessions$15
Supervised Exercise Therapy (SET)$15
Emergency Services$150
Urgently Needed Services$65
Worldwide Emergency & Urgent CoverageSee plan details
Worldwide Emergency Coverage$150
Worldwide Emergency Transportation$325
Partial Hospitalization Program$35
Intensive Outpatient Program (IOP)$35
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Diagnostic Tests & Lab ServicesSee plan details
Chiropractic Services$20
Occupational Therapy Services$25
Physician Specialist Services$25
Podiatry Services$25
Other Health Care Professional Services$0-$25
Psychiatric ServicesSee plan details
Psychiatric Services — Individual Sessions$35
Psychiatric Services — Group Sessions$35
Physical Therapy & Speech-Language Pathology$25
Additional Telehealth Services (Part B)$0-$65
Opioid Treatment Program Services$35
Laboratory ServicesNo charge
Radiological ServicesSee plan details
Diagnostic Radiology$0-$345
Therapeutic Radiology$25 copay + 20% coinsurance
X-Ray Services$0-$145
Outpatient Hospital Services$0-$225
Hospital Observation Services$195 per stay
Ambulatory Surgical Center (ASC)$0-$150
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual Sessions$35
Substance Abuse — Group Sessions$35
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance$325
Air Ambulance20% coinsurance
Durable Medical Equipment (DME)20% coinsurance
Prosthetic Devices20% coinsurance
Medical Supplies20% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic Supplies10%-20% coinsurance
Diabetic Therapeutic Shoes & Inserts$10
Diabetic Monitors10%-20% coinsurance
Dialysis Services20% coinsurance
Acupuncture$25
Meal BenefitNo charge
Medicare-Covered Preventive ServicesSee plan details
Annual Physical ExamNo charge
Fitness BenefitNo charge
In-Home Support ServicesNo charge
Kidney Disease Education ServicesNo charge
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)0%-20% coinsurance (max $35)
Dental — Medicare-Covered Services$25
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — ComprehensiveSee plan details
Dental — Restorative Services0%-30% coinsurance
Dental — Endodontics (Root Canal)0%-30% coinsurance
Dental — Periodontics (Gum Care)0%-30% coinsurance
Dental — Removable Prosthodontics (Dentures)30% coinsurance
Dental — Fixed Prosthodontics (Bridges)0%-30% coinsurance
Dental — Oral & Maxillofacial Surgery0%-30% coinsurance
Dental — Adjunctive General Services30% coinsurance
Vision — Eye Exams$0-$25
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Hearing — Exams$25
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)$575-$750
Cardiac & Pulmonary RehabilitationSee plan details

Service area

  • TN: 10 counties

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