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Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H0028-015 (HMO-POS 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 H0028-015 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Missouri. 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 H0028-015 (HMO-POS 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 H0028-015 (HMO-POS 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 H0028-015 (HMO-POS 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 H0028-015 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 H0028-015 (HMO-POS D-SNP) plan has a $590.00 deductible for prescription drugs. Once the deductible is met, you pay the costs for drugs in each tier until your total drug costs reach $2000.00. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you qualify, the monthly premium for Part D is $40.30. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP) plan offers comprehensive coverage with a range of benefits. It includes coverage for inpatient hospital stays with a copay per admission, and outpatient services with 20% coinsurance. Emergency and urgent care services have copays, and transportation to health-related locations is available with no copay for a limited number of trips. This plan provides coverage for primary care, preventive services, hearing, vision, and dental services, with varying copays and coinsurance. It also includes coverage for home infusion, dialysis, medical equipment, and diagnostic services, with some services requiring prior authorization. Additional benefits include home health services with no copay, skilled nursing facility stays with a copay, and other services like acupuncture and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, the copay is $2185 per admission or stay, and for Inpatient Hospital Psychiatric, the copay is $2036 per admission or stay; additional days and upgrades for Inpatient Hospital-Acute, as well as non-Medicare-covered stays for both are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services, all with a 20% coinsurance. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization, with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance; Transportation Services to a plan-approved health-related location have no copay for up to 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all have no coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP) plan covers Primary Care Physician Services, Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services with a 20% coinsurance. Chiropractic Services, Occupational Therapy Services, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a 20% coinsurance. Additional Telehealth Benefits are covered with a coinsurance of 20% and a copay between $0 and $45. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services. Additional preventive services, including Fitness Benefit (Memory Fitness) and Kidney Disease Education Services, have a $0 copay. Some preventive services, such as Health Education, are not covered.
Hearing Services See details
The Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP) plan covers hearing exams with a coinsurance of at most 20% for routine exams, and also covers fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay and a maximum benefit of $2,000 per year, and OTC hearing aids are covered with a $0 copay and a maximum benefit of $2,000 per ear, per year.
Vision Services See details
The Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay, and eyewear with no copay, with a combined maximum benefit of $500 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. Other dental services have a $5,000 maximum benefit per year, and include 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, all with no copay. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
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, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance and no copay. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 19% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 20% coinsurance for Diabetic Supplies and a $0 copay for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP) plan covers diagnostic and radiological services with prior authorization. Diagnostic Procedures/Tests have a coinsurance of at most 20% and a copay of at most $45, and Lab Services have a coinsurance of at most 20% and no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of $215 to $350, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a coinsurance of at most 20% and a copay of $45.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the services. The plan requires prior authorization for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP) plan covers acupuncture with a 20% coinsurance, and a meal benefit with no copay. Over-the-counter items are covered with a maximum benefit coverage amount of $1680.
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