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Humana Gold Plus H0028-017 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-017 (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 H0028-017 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-017 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Kansas City. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-017 (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 H0028-017 (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 H0028-017 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.00. 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 $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 $7000.00 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 H0028-017 (HMO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, the copay for a standard generic drug is $11.00-$47.00, while the coinsurance for a preferred brand drug is 50%. After your total drug costs reach $2000.00, you will enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H0028-017 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary. Emergency services have a $110 copay. This plan includes no copay for primary care physician services, routine hearing exams, and eyewear. It also covers preventive services, with many other services having copays, such as chiropractic, specialist, and mental health services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $450 copay for days 1-5, and no copay for days 6-90, and additional days have no copay; however, Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, there is a $405 copay for days 1-5, and no copay for days 6-90, while Additional Days and Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, with copays ranging from $0 to $300, and outpatient blood services and ambulatory surgical center (ASC) services, both with no copay. Outpatient substance abuse services cover individual and group sessions, each with a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0028-017 (HMO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0028-017 (HMO) plan. 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 H0028-017 (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services have a $45 copay, and all services have no coinsurance.
Primary Care See details
The Humana Gold Plus H0028-017 (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $40 copay, and Mental Health Specialty Services with a $40 copay. The plan also covers Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits with a copay between $0 and $45, and Opioid Treatment Program Services with a $40 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive services, including an annual physical exam, are covered under this plan. The annual physical exam has no copay. Other preventive services may have a copay.
Hearing Services See details
The Humana Gold Plus H0028-017 (HMO) plan covers hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H0028-017 (HMO) plan covers vision services, including routine eye exams with a copay of $0-$40 and eyewear with a $0 copay, including contact lenses and eyeglasses (lenses and frames), with a combined maximum benefit of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H0028-017 (HMO) plan covers dental services, including oral exams and x-rays with no copay, and other diagnostic and preventive services with no copay. Restorative services have a $25 copay, and adjunctive general services have no copay. However, fluoride treatments, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, 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 other Medicare Part B drugs, all with a coinsurance between 0% and 20%; prior authorization is required. The plan also covers Medicare Part B Chemotherapy/Radiation Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance between 20% and 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), with a 20% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic equipment is covered with a coinsurance and copay, and Diabetic Supplies have a coinsurance between 10-20% with no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay ranging from $0 to $45, and lab services with no copay. Radiological services are also covered, with diagnostic radiological services having a maximum copay of $350, therapeutic radiological services having a copay of $35, and outpatient X-ray services with no copay.
Home Health Services See details
Home health services are covered by the Humana Gold Plus H0028-017 (HMO) 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 H0028-017 (HMO) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H0028-017 (HMO). 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 are not covered.
Other Services See details
Other Services include acupuncture, which has a $40 copay per visit up to 20 visits per year, and a meal benefit with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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