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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 2025, 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 2025.
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 $16.00. 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 $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 $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) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For Tier 1 and 2 drugs, you will pay a copay between $11 and $47, depending on the pharmacy. Tier 3 and 4 drugs have a 25% or 50% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H0028-016 (HMO-POS) plan offers a variety of benefits, including inpatient hospital stays with copays, outpatient services with copays ranging from $0-$300, and emergency services with a $110 copay. Primary care visits have a $10 copay, and specialist visits have a $50 copay. Preventive services include an annual physical exam with no copay. Hearing services include hearing exams and hearing aids with copays, and vision services cover routine eye exams and eyewear with no copay. Dental services cover a range of services with varying copays and coinsurance, and home health services have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a $270 copay for days 1-8 and no copay for days 9-90, and Inpatient Hospital Psychiatric with a $230 copay for days 1-8 and no copay for days 9-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $300, and observation services with a $270 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while individual and group sessions for outpatient substance abuse have copays between $40 and $45.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H0028-016 (HMO-POS) plan. This benefit requires prior authorization and has a copay of $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H0028-016 (HMO-POS). Ground ambulance services have a $315 copay, and air ambulance services have 20% coinsurance; however, 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. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay, while Urgently Needed Services has a $45 copay.
Primary Care See details
The Humana Gold Plus H0028-016 (HMO-POS) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay (prior authorization required), and occupational therapy services with a $35 copay (prior authorization required). The plan also covers physician specialist services with a $50 copay, mental health specialty services with a $45 copay, and physical therapy and speech-language pathology services with a $35 copay.
Preventive Services See details
The Humana Gold Plus H0028-016 (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services such as health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $50 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a copay between $699 and $999. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0, and eyewear with a copay of $0. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $50 copay, and other dental services with a $1,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Restorative Services and Prosthodontics, removable are covered with no copay and 30-40% and 30% coinsurance, respectively. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H0028-016 (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0028-016 (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $90, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $350, Therapeutic Radiological Services have a $50 copay, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H0028-016 (HMO-POS) 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 not covered by the Humana Gold Plus H0028-016 (HMO-POS) 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 the Humana Gold Plus H0028-016 (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $203 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 H0028-016 (HMO-POS) plan covers acupuncture with a $50 copay, and a limit of 20 treatments per year, as well as a meal benefit with no copay. Other services such as over-the-counter items, and several other services are not covered.
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