Yes, Humana Gold Plus is a Medicare Advantage plan

Humana Gold Plus is a Medicare Advantage plan — also called Part C — offered by Humana Insurance Company. It combines your hospital coverage (Part A), doctor visits (Part B), and usually prescription drug coverage (Part D) into a single plan. Instead of paying Medicare directly, you pay Humana a monthly premium and use their network of doctors and hospitals.

Medicare Advantage plans differ from Original Medicare (Parts A and B alone) because they come with network restrictions, copays for most services, and annual out-of-pocket limits. Humana Gold Plus is available in certain counties and states, not nationwide, so whether you can enroll depends on where you live.

Key Takeaways

  • Humana Gold Plus is a Medicare Advantage plan that bundles hospital, doctor, and prescription drug coverage under one insurer instead of Original Medicare.
  • You must live in a county where Humana Gold Plus is offered and be enrolled in Medicare Parts A and B to join during the annual enrollment period (October 15 to December 7) or when you first turn 65.
  • The plan includes an annual out-of-pocket spending limit, meaning your costs stop once you reach that cap, unlike Original Medicare.
  • You must use Humana's network doctors and hospitals, except in emergencies, and will pay copays for most visits and services.
  • You can switch back to Original Medicare during the annual enrollment period or during the Medicare Advantage Open Enrollment Period (January 1 to March 31).

How Humana Gold Plus differs from Original Medicare

Original Medicare (Parts A and B) lets you see any doctor or hospital that accepts Medicare, anywhere in the country. You pay a deductible and coinsurance, but there is no annual cap on what you spend out of pocket. Humana Gold Plus, by contrast, restricts you to in-network providers (except emergencies), charges copays instead of coinsurance for most services, and stops charging you once you hit your annual out-of-pocket maximum.

Original Medicare does not include prescription drug coverage — you must buy Part D separately or go without. Humana Gold Plus includes drug coverage as part of the plan, so you do not need to buy a separate prescription drug plan. This bundling can lower your total monthly cost, but it ties your drug coverage to Humana's formulary (the list of drugs they cover).

If you travel frequently or see specialists outside your area, Original Medicare offers more freedom. If you want predictable copays and a spending cap, Humana Gold Plus may cost less over the year.

What coverage Humana Gold Plus includes

Humana Gold Plus covers hospital stays (Part A), doctor visits and outpatient care (Part B), and prescription drugs (Part D). Most plans also include dental, vision, and hearing benefits — though the scope varies by plan and county. Some versions offer a fitness benefit or allowance toward over-the-counter items.

You will pay a copay when you see a doctor, go to urgent care, or fill a prescription. The copay amount depends on the specific plan and your location. Hospital stays, emergency room visits, and specialist referrals each have their own copay structure. Once your total out-of-pocket spending reaches the annual limit (which varies by plan), Humana covers the rest of your care for the remainder of that calendar year.

Not all services are covered equally. Some preventive care — like annual wellness visits and certain screenings — may be covered with no copay. Others, like physical therapy or mental health visits, may require a copay or have a limit on how many visits you can have per year.

Who can enroll in Humana Gold Plus

You must be 65 or older and enrolled in Medicare Parts A and B to join Humana Gold Plus. You also must live in a county where the plan is offered — Humana does not serve every area. You can check whether Humana Gold Plus is available in your zip code on Medicare.gov or by calling 1-800-MEDICARE.

You can enroll during the Annual Enrollment Period (October 15 to December 7 each year), when your coverage starts January 1. If you are newly may be able to access for Medicare (turning 65 or losing employer coverage), you have a seven-month Initial Enrollment Period centered on your birthday month. Outside these windows, you generally cannot switch to Humana Gold Plus unless you experience a may have access to life event, such as moving out of your plan's service area or losing other health coverage.

If you are already in a different Medicare Advantage plan, you can switch to Humana Gold Plus during the Annual Enrollment Period. You can also switch during the Medicare Advantage Open Enrollment Period (January 1 to March 31), but only if you are already in a Medicare Advantage plan — you cannot use this window to switch from Original Medicare.

Network doctors and how to use them

Humana Gold Plus requires you to use doctors, hospitals, and pharmacies in their network. If you see an out-of-network provider without prior authorization, you may pay the full bill yourself. The exception is emergency care — if you have a heart attack or serious injury, any hospital can treat you, and Humana will cover it.

Before your first visit, ask your current doctor whether they accept Humana Gold Plus in your area. If not, you will need to find a new primary care doctor within the network. Your primary care doctor coordinates your care and provides referrals to specialists. You can find Humana's network doctors on their website or by calling the member services number on your Medicare card.

Prescription drugs must be filled at a pharmacy in Humana's network, usually including major chains like CVS, Walgreens, and Walmart, plus local pharmacies. Mail-order and specialty pharmacies are also available for some medications. Check Humana's formulary to confirm your medications are covered before you enroll.

Costs: premiums, copays, and out-of-pocket limits

Humana Gold Plus plans have a monthly premium, which varies by plan and location. Some plans have a $0 premium, meaning you pay only Medicare Part B premiums (currently $164.90 per month for most people in 2024, though this amount changes yearly). Other plans charge an additional premium on top of Part B.

You will pay copays for doctor visits, urgent care, emergency room visits, hospital stays, and prescriptions. A routine doctor visit might cost $10 to $40, depending on the plan. Specialist visits often cost more. Prescription copays range from $0 for generic drugs to $100 or more for brand-name medications not on the preferred tier.

Every Humana Gold Plus plan has an annual out-of-pocket maximum. Once your copays and coinsurance add up to that limit in a calendar year, Humana covers the rest of your care at no cost. This maximum varies by plan but is capped by Medicare at a certain amount each year. Original Medicare has no such cap, so your costs can be unlimited.

When to choose Humana Gold Plus over Original Medicare

Humana Gold Plus may be the better choice if you want predictable costs with a spending cap, prefer seeing the same doctors regularly, and do not mind using a network. It is also useful if you take multiple prescription drugs, because the plan includes drug coverage and may cost less than buying Original Medicare plus a separate Part D plan.

If you have a chronic condition that requires frequent specialist visits, check whether your specialists are in Humana's network before enrolling. If they are, the copay structure may save you money compared to Original Medicare's coinsurance. If they are not, you may need to switch doctors or choose Original Medicare instead.

Humana Gold Plus is less suitable if you travel often, see doctors in multiple states, or have a strong preference for a specific doctor outside the network. It is also not ideal if you want maximum freedom to see any provider without restrictions. In those cases, Original Medicare may serve you better, even though it costs more out of pocket.

How to switch plans if Humana Gold Plus is not right for you

If you enroll in Humana Gold Plus and later decide it is not working for you, you have options. During the Annual Enrollment Period (October 15 to December 7), you can switch to a different Medicare Advantage plan, return to Original Medicare, or join a standalone Part D plan if you switch to Original Medicare.

If you are already in Humana Gold Plus, you can also switch during the Medicare Advantage Open Enrollment Period (January 1 to March 31). This window allows you to change to a different Medicare Advantage plan or return to Original Medicare, but only once per year. Any changes made during this period take effect the first day of the following month.

If you experience a may have access to life event — such as moving out of the plan's service area, losing other health coverage, or a death in your family — you may be able to switch outside the normal enrollment windows. Contact Humana or Medicare to report the event and ask whether you are may be able to access for a Special Enrollment Period.

Frequently Asked Questions

Can I use Humana Gold Plus if I move to a different state?

No. Medicare Advantage plans are county-specific. If you move, you must check whether Humana Gold Plus is offered in your new county. If it is not, you can switch to Original Medicare or a different plan during your move, even outside the normal enrollment period. Contact Medicare or Humana to report your move and see what options are available in your new location.

What happens if my doctor leaves Humana's network?

If your primary care doctor or specialist leaves the network, Humana must notify you and give you time to find a new provider or request a continuity-of-care exception. In some cases, you can continue seeing the doctor for a limited time while you transition. You can also use this as a reason to switch to a different plan during a Special Enrollment Period.

Do I still pay Medicare Part B premiums with Humana Gold Plus?

Yes. You must continue paying your Medicare Part B premium (currently $164.90 per month for most people in 2024) in addition to any Humana Gold Plus premium. Some Humana Gold Plus plans have a $0 additional premium, so your only cost is Part B. Others charge an extra monthly premium on top of Part B.

Can I use Humana Gold Plus outside the United States?

Most Medicare Advantage plans, including Humana Gold Plus, do not cover care outside the United States except in limited situations (such as emergency care in Canada or Mexico near the U.S. border). If you travel internationally, check Humana's coverage rules before you go, or consider Original Medicare, which also does not cover foreign care but gives you more flexibility to pay out of pocket.

What if I want to go back to Original Medicare after enrolling in Humana Gold Plus?

You can switch back to Original Medicare during the Annual Enrollment Period (October 15 to December 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31). If you switch to Original Medicare, you will also need to enroll in a standalone Part D prescription drug plan during the same window, or you may face a late-enrollment penalty if you go without drug coverage.