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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 2026, 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 2026.
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 $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 $6800.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost as little as a $5 copay for a one-month supply, with no copay for a three-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with three-month supplies ranging from $131 to $141 depending on your pharmacy choice. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 37% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. This structure helps you estimate your out-of-pocket prescription costs when choosing between retail pharmacies and mail-order services.
Additional Benefits
The Humana Gold Plus H0028-017 (HMO) plan offers comprehensive coverage for essential medical needs, featuring no copays for primary care doctor visits, preventive services, and home health care. Specialist physician visits require a $40 copay, while inpatient hospital stays incur a daily copay of $450 for the first five days of an acute stay with no coinsurance. Emergency room care has a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes valuable supplemental benefits, providing routine dental, vision, and hearing exams with no copays, alongside a $1,000 annual limit for preventive dental care. Prescription hearing aids are covered with copays ranging from $699 to $999, and routine eyewear is available with no copay up to a $100 yearly limit. For durable medical equipment, dialysis services, and air ambulance transportation, members can expect a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H0028-017 (HMO) covers inpatient hospital services with no coinsurance, requiring a $450 daily copay for days 1-5 of an acute stay (no copay for days 6 and beyond) and a $405 daily copay for days 1-5 of a psychiatric stay (no copay for days 6-90). Prior authorization is required, and some services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H0028-017 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services, a $450 copay per stay for observation services, and a $30 to $35 copay for substance abuse sessions. Ambulatory surgical center and outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H0028-017 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-017 (HMO) covers ground ambulance services with a $325 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services are technically covered, but trips to plan-approved or any health-related locations are not covered in practice.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H0028-017 (HMO) 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, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-017 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, and speech therapies require a $25 copay and no coinsurance, while podiatry is not covered and chiropractic services are partially covered, with routine and other chiropractic services not covered.
Preventive Services See details
Humana Gold Plus H0028-017 (HMO) covers preventive services with no copay and no coinsurance, including annual physicals, kidney disease education, memory fitness, and glaucoma screenings. Other additional preventive benefits are only partially covered, as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus H0028-017 (HMO) with no coinsurance, featuring no copay for annual routine exams and fitting evaluations, and a $40 copay for Medicare-covered exams. Up to two prescription hearing aids are covered yearly with a $699 to $999 copay, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Humana Gold Plus H0028-017 (HMO) provides partially covered vision services with no coinsurance, no deductibles, and prior authorization requirements. Routine eye exams and eyewear, such as one annual pair of contact lenses or eyeglasses up to a $100 yearly limit, are available with no copay, while other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H0028-017 (HMO) with no copay and no coinsurance for preventive care up to a $1,000 annual limit, while Medicare-covered dental services require a $40 copay and no coinsurance. Restorative services have a $25 copay and no coinsurance, but fluoride treatments, 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 H0028-017 (HMO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, insulin, and other drugs require no coinsurance to 20% coinsurance, with insulin drugs also having a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-017 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H0028-017 (HMO) 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 applicable coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-017 (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays have no copay, diagnostic procedures range from a $0 to $45 copay, and therapeutic radiology requires a minimum copay of $40.
Home Health Services See details
Home health services are covered by Humana Gold Plus H0028-017 (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H0028-017 (HMO) plan, as none of the key sub-services—including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-017 (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, as additional days beyond the standard Medicare benefit are not covered. For covered days, there is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, requiring prior authorization but no prior three-day inpatient hospital stay.
Other Services See details
Humana Gold Plus H0028-017 (HMO) partially covers other services, offering acupuncture for a $40 copay and no coinsurance up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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