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Humana Gold Plus H0028-016 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-016 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H0028-016 (HMO-POS) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-016 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Springfield/Joplin. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-016 (HMO-POS) 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 H0028-016 (HMO-POS).
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 H0028-016 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.00. 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 $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 $7550.00 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 H0028-016 (HMO-POS) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using a standard pharmacy or preferred mail order service for both 1-month and 3-month supplies. Tier 2 generic medications cost as little as a $5 copay for a 1-month supply, and there is no copay required for a 3-month supply filled through preferred mail order. For Tier 3 preferred brand drugs, the plan requires a $47 copay for a 1-month supply across standard pharmacies and mail order services. Tier 4 non-preferred drugs require a 40% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty medications carry a 25% coinsurance for a 1-month supply through standard pharmacies and mail order options.
Additional Benefits
The Humana Gold Plus H0028-016 (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, key preventive services, and lab tests. Specialist visits require a $50 copay, while inpatient hospital stays carry a $270 daily copay for the first eight days with no copay for the ninth day and beyond. Emergency care is available with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. For routine care, members enjoy no copays for annual vision and hearing exams, alongside dental coverage up to a $1,000 annual limit with no copay for most preventive services. Skilled nursing facility care features no copay for the first 20 days, while durable medical equipment and dialysis services require a 20% coinsurance. Other benefits include home health services with no copay and acupuncture with a $50 copay.
Inpatient Hospital See details
Humana Gold Plus H0028-016 (HMO-POS) covers inpatient acute hospital stays with no coinsurance and a daily copay of $270 for days 1 through 8, with no copay for days 9 and beyond. Inpatient psychiatric care is also covered with no coinsurance and a daily copay of $230 for days 1 through 8, though hospital upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H0028-016 (HMO-POS) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $300 copay, observation services require a $270 copay per stay, and outpatient substance abuse sessions carry a $30 to $35 copay, with prior authorization required for most benefits.
Partial Hospitalization See details
Humana Gold Plus H0028-016 (HMO-POS) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-016 (HMO-POS) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H0028-016 (HMO-POS) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-016 (HMO-POS) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Therapy, mental health, and psychiatric services feature copays ranging from $30 to $35 with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H0028-016 (HMO-POS) covers key preventive services, including annual physical exams, kidney disease education, select screenings, and a memory fitness benefit, with no copay and no coinsurance. This benefit is partially covered, as supplemental services such as health education, nutritional therapy, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Humana Gold Plus H0028-016 (HMO-POS) covers hearing exams with a $50 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two aids per year, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Humana Gold Plus H0028-016 (HMO-POS) partially covers vision services with no coinsurance, no deductibles, and prior authorization requirements. One annual routine eye exam and select eyewear (one pair of eyeglasses or contact lenses) are covered with no copay up to a $100 annual limit, while separate eyeglass lenses, separate frames, upgrades, and other eye exams are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H0028-016 (HMO-POS) up to a $1,000 annual limit, with no copay and no coinsurance for most preventive and comprehensive services. Medicare-covered dental requires a $50 copay and no coinsurance, prosthodontics require a 30% coinsurance and no copay, while fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-016 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-016 (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H0028-016 (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-016 (HMO-POS) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. There is no copay for lab services, outpatient X-rays, or diagnostic radiological services, while diagnostic procedures range from $0 to $90, and therapeutic radiology has a minimum $50 copay.
Home Health Services See details
Humana Gold Plus H0028-016 (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Humana Gold Plus H0028-016 (HMO-POS) with no coinsurance and copays ranging from no copay to $30, requiring prior authorization. While some services are covered, the plan does not cover cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-016 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a daily copay of $218 for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H0028-016 (HMO-POS) partially covers other services, which include acupuncture for a $50 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance, both requiring prior authorization. Over-the-counter (OTC) items are not covered under this benefit.
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