Humana Gold Plus H4007-012 (HMO) 2025 Plan Details for Adjuntas Municipio, Puerto Rico Residents
Humana Gold Plus H4007-012 (HMO) 2025 Plan Details for Adjuntas Municipio, Puerto Rico Residents
Navigating your Medicare Advantage options in Adjuntas Municipio for 2025 can be overwhelming, but we're here to help. With Humana Gold Plus H4007-012 (HMO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
Based on May, 2025 CMS enrollment data, an estimated 1,109 Medicare beneficiaries are enrolled in this plan, with 12 members in Adjuntas Municipio, PR.
Humana Gold Plus H4007-012 Overview
| Plan ID H4007-012-0 Overview | |
|---|---|
| Health Plan ID: | H4007-012-0 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $5,000.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Adjuntas Municipio, PR |
| Insured By: | Humana |
Why Consider Humana Gold Plus H4007-012 ?
With a monthly premium of $0.00, Humana Gold Plus H4007-012 brings together hospital, medical, and prescription drug coverage in one coordinated Medicare Advantage HMO plan. It includes the core benefits of Medicare Part A and Part B, plus drug coverage to help manage your ongoing prescriptions. There is no annual deductible. Cost sharing begins with your first prescription. As with most HMO plans, you’ll typically need to use in-network providers to keep costs predictable.
This plan is officially listed as CMS plan H4007-012-0. It features a maximum out-of-pocket (MOOP) limit of $5,000.00 , capping your annual healthcare spending. Once you reach that limit, your in-network care is covered at 100% for the rest of the year — a strong choice for anyone who wants bundled coverage and financial protection they can count on.
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Out-of-Pocket Costs
Humana Gold Plus H4007-012 has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H4007-012-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $0 Copay Referral Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $50 Copay |
| Urgent care: | $10 Copay |
| Ground ambulance: | $50 Copay |
| Inpatient hospital care: | $25.00 per stay |
| Skilled Nursing Facility: | $0.00 per stay |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $0 Copay |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $0 Copay Referral Required |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $0 Copay |
| Outpatient group therapy: | $0 Copay |
| Inpatient psychiatric hospital care: | $25.00 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $6 Copay Prior Authorization Required |
| Occupational therapy: | $6 Copay Prior Authorization Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay |
| Durable medical equipment: | $0 Copay Prior Authorization Required |
| Prosthetics: | Not Covered |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $25 Copay Prior Authorization Required |
| Lab services: | $0 Copay Prior Authorization Required, Referral Required |
| Outpatient x-rays: | $10 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $20 Copay Prior Authorization Required, Referral Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | $0 Copay Prior Authorization Required |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 Copay |
| Routine eye exam (in-network) | $0 Copay Prior Authorization Required, 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $500.00 Every year |
Certain preventive services are covered 100% by Humana Gold Plus H4007-012 as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Humana Gold Plus H4007-012 includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $(40.40) |
|---|---|
| Supplemental Part D Premium: | $40.40 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Humana starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Humana Gold Plus H4007-012 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $0.00 |
| Generic | $0.00 | $0.00 |
| Preferred Brand | $5.00 | $6.00 |
| Non-Preferred Drug | 31.00% | 31.00% |
| Specialty Tier | 33.00% | 33.00% |
| Select Care Drugs | $0.00 | $0.00 |
| *Deductible does not apply. | ||
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in Humana Gold Plus H4007-012 ?
You are eligible to enroll in Humana Gold Plus H4007-012 if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for Humana Gold Plus H4007-012 and take advantage of its full range of benefits.
When Should You Enroll in Humana Gold Plus H4007-012 ?
Understanding the right time to enroll in Humana Gold Plus H4007-012 is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
Steps to Enroll in Humana Gold Plus H4007-012
Enrolling in Humana Gold Plus H4007-012 is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Humana Gold Plus H4007-012 through the official Medicare website.
- Directly with Humana Gold Plus H4007-012 : You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Contact Humana
| Website: | Humana Plan Page |
|---|---|
| Providers: | Humana Providers Page |
| Formulary: | Humana Formulary Page |
| Pharmacy: | Humana Pharmacy Page |
| New Member Health Plan Help: | (800)681-3625 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)681-3625 |
| New Member Part D TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- Humana, http://www.humana.com/medicare, Last Accessed June 1, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 25 May, 2025
- Medicare.gov, "Joining a plan", Last Accessed 25 May, 2025
- Medicare.gov, "Your coverage options", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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