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Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Omaha. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $50.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, your costs will vary depending on the drug tier and pharmacy type. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. The plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance. Many services, such as preventive services, blood services, and home health services, have no copay. The plan also covers hearing, vision, and dental services with specific cost-sharing structures and annual maximums. This plan includes coverage for ambulance and transportation, emergency services, and a variety of therapies, such as primary care, chiropractic, and cardiac rehabilitation. Additionally, it offers benefits for home infusion, dialysis, and medical equipment, with different cost-sharing arrangements. Other notable benefits include coverage for over-the-counter items and a meal benefit, while some services like private duty nursing and certain rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, there is a $2,185 copay per admission or stay, and for Inpatient Hospital Psychiatric, there is a $2,036 copay per admission or stay.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) Services, and outpatient substance abuse services are covered, with a 20% coinsurance. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) plan, including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance; transportation services to plan-approved health-related locations have no copay, with a limit of 48 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services have a 20% coinsurance.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered with a 20% coinsurance. Chiropractic Services are partially covered, and Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services, including Medicare-covered zero dollar services and annual physical exams, are covered with no copay. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit also have no copay.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids have a plan maximum benefit coverage of $2,000 per ear every year, with no copay for prescription hearing aids (all types). OTC hearing aids have no copay, with a maximum of $2,000 per ear every year.
Vision Services See details
The Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance. Eyewear has a combined maximum benefit of $500 per year. Contact lenses and eyeglasses (lenses and frames) have no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with coinsurance of 20% for Medicare dental services. Other dental services have a maximum benefit of $5,000 per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implants services, and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and no copay. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and no copay. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under this plan. Diagnostic Procedures/Tests have a coinsurance of up to 20%, and Lab Services have no copay and a coinsurance of up to 20%. Diagnostic Radiological Services have a copay of up to $350 and a coinsurance of up to 20%, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance; however, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally not covered by the Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) plan. Specifically, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture with 20% coinsurance and a limit of 20 treatments per year, over-the-counter (OTC) items with a maximum benefit coverage amount of $1860 per year, and a meal benefit with no copay. Additionally, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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