A non-government entity
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 2026, 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 2026.
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 $35.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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 $615.00 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 $9250.00 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:
Sign up for Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when filling prescriptions through standard pharmacies or preferred mail order. If you choose standard mail order, copays range from $10 to $30 for Tier 1 and $20 to $60 for Tier 2 medications. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you are responsible for a 25% coinsurance. This 25% coinsurance rate applies to both standard pharmacy and mail order options for these higher-tier medications. This clear cost structure helps you estimate your out-of-pocket prescription expenses under this plan.
Additional Benefits
The Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) offers comprehensive healthcare coverage with no copays for primary care, specialist visits, and outpatient services, though a 20% coinsurance generally applies. Inpatient acute hospital stays require a $2,230 copay with no coinsurance, while emergency room care is available with a $115 copay. Members also benefit from home health care and the first 20 days of skilled nursing facility care at no cost, with no copay or coinsurance required. This plan also includes extensive supplemental benefits, such as dental coverage up to a $4,000 annual limit and a $350 yearly eyewear allowance with no copays. Routine hearing exams, up to $2,000 per ear annually for prescription hearing aids, and up to 48 one-way transportation trips to plan-approved locations are also covered with no copays. Additionally, over-the-counter items and chronic illness meal benefits are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copayment per acute stay and a $2,080 copayment per psychiatric stay. Prior authorization is required, and while unlimited additional acute days are covered at no copay, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and outpatient substance abuse services with no copay and 20% coinsurance. Outpatient blood services are covered with no copay and no coinsurance, and prior authorization is required for these outpatient services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to a $40 maximum) and no copay, while worldwide emergency, urgent, and transportation services are available with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) covers primary care, specialist visits, therapies, mental health, psychiatric, and telehealth services with no copay and a 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered under the Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) plan, offering no copays and no coinsurance for covered benefits like annual physical exams, memory fitness, kidney disease education, and glaucoma screenings. However, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary services, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home/bathroom safety, and counseling.
Hearing Services See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) covers hearing services with no deductible, offering routine exams with no copay and a 20% coinsurance, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $2,000 per ear per year, excluding inner ear, outer ear, and over the ear models, while up to two OTC hearing aids are covered annually with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP), featuring one annual routine eye exam with no copay and 20% coinsurance, and a $350 yearly eyewear allowance with no copay and up to 20% coinsurance. Prior authorization is required, and other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) offers partially covered dental services with no copay and 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $4,000 annual limit. While many preventive and comprehensive dental services are covered, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) with prior authorization and step therapy requirements. Covered Part B insulin requires a $35 copay and 0% to 20% coinsurance, while other Part B drugs carry no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) covers medical equipment—including durable medical equipment, prosthetics, medical supplies, and diabetic services—with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) covers diagnostic and radiological services with a 20% coinsurance and no copay for lab services, diagnostic procedures, diagnostic radiology, and X-rays. Therapeutic radiological services require a copay and a 20% coinsurance, and prior authorization is required for all of these services.
Home Health Services See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) indicates that some cardiac rehabilitation services are covered with no copay and no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the standard Medicare limit.
Other Services See details
Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) partially covers other services, including acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits, while other specific services are not covered. Acupuncture is available with no copay and 20% coinsurance for up to 20 treatments per year, while OTC items and meal benefits are covered with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved