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Humana Gold Plus H0028-014 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-014 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H0028-014 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-014 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in St. Louis Metro area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-014 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus H0028-014 (HMO).
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 H0028-014 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $250.00 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 $2700.00 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 H0028-014 (HMO) plan has a $250 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $5 copay for preferred generic drugs at a preferred pharmacy, but 45% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H0028-014 (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $245 copay for the first eight days, while outpatient services and emergency services come with copays between $0 and $300. The plan also includes coverage for primary care with no copay, hearing and vision services with no copay for some services, and dental services with no copay for most services. Additionally, the plan provides coverage for home health services with no copay, and offers a quarterly over-the-counter benefit.
Inpatient Hospital See details
Inpatient hospital stays, including acute and psychiatric, are covered with a $245 copay for days 1-8, and no copay for days 9-90. Additional days for inpatient hospital-acute have no copay, and non-Medicare covered stays and upgrades for inpatient hospital-acute are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $300, observation services with a $245 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $40 and $45 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H0028-014 (HMO) plan, but requires prior authorization. The copay for this benefit is $35.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. 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 H0028-014 (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $65 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
For Humana Gold Plus H0028-014 (HMO), primary care physician services have no copay, chiropractic services have a $20 copay, and occupational therapy services have a $35 copay. Physician specialist services have a $25 copay, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $0 and $65. Mental health and psychiatric services have a $40 copay. Opioid treatment program services have a copay between $40 and $45. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, additional preventive services with varying copays, kidney disease education with no copay, glaucoma screenings with no copay, diabetes self-management training with no copay, barium enemas with no copay, digital rectal exams with no copay, and EKG following Welcome Visit with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing exams have a $25 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, with coverage for all types with a copay between $699 and $999 per year, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered with a maximum benefit of $50 every three months.
Vision Services See details
The Humana Gold Plus H0028-014 (HMO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams, contact lenses, and eyeglasses have no copay; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $25 copay for Medicare Dental Services and no copay for other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, and 30-40% coinsurance for restorative and fixed prosthodontics, and 30% coinsurance for removable prosthodontics. Fluoride treatment, 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 H0028-014 (HMO), including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-014 (HMO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has an 18% coinsurance with no copay, while Prosthetic Devices and Medical Supplies have 20% coinsurance and no copay. Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Humana Gold Plus H0028-014 (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $65, lab services with no copay, diagnostic radiological services with a copay up to $350, therapeutic radiological services with a copay up to $35, and outpatient X-ray services with no copay. All services may require prior authorization.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-014 (HMO) plan 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 not covered by the Humana Gold Plus H0028-014 (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H0028-014 (HMO), but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with a $25 copay, over-the-counter items, and a meal benefit with no copay. The over-the-counter benefit provides up to $50 every three months for qualifying items. This plan does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and many other services.
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