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Humana Gold Plus H0028-019 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-019 (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 H0028-019 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-019 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Albuquerque Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-019 (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 H0028-019 (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 H0028-019 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4150.00 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 H0028-019 (HMO) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, a standard generic drug has a $45 copay, while preferred brand drugs have 50% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H0028-019 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $325 copay for the first six days, with no copay thereafter. Outpatient services, including primary care, often have no copay, while specialist visits and some therapies have copays between $20 and $40. The plan also covers emergency services with a copay, and offers transportation services with a $0 copay for plan-approved health-related locations. Preventative and dental services are covered with no copay, while hearing and vision services have some coverage for exams and eyewear with no copay for routine exams. The plan also includes additional benefits like home health services and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered with prior authorization. For days 1-6, the copay is $325, and for days 7-90, there is no copay; additional days for inpatient hospital-acute have no copay.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $325, observation services have a $325 copay, ambulatory surgical center services have no copay, and both individual and group sessions for outpatient substance abuse have a $40 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Humana Gold Plus H0028-019 (HMO) with a $100 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $315 copay, and air ambulance services have a $630 copay. Transportation services to a plan-approved health-related location are covered with a $0 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 by Humana Gold Plus H0028-019 (HMO). Emergency Services have a $140 copay, while Urgently Needed Services have a $55 copay, and both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay, and no coinsurance.
Primary Care See details
The Humana Gold Plus H0028-019 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $25 copay, and physician specialist services with a $25 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions, podiatry services have a $25 copay, and physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay between $0 and $55, and opioid treatment program services have a $40 copay.
Preventive Services See details
The Humana Gold Plus H0028-019 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are covered up to $100 every three months.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $25, and routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses (lenses and frames), have no copay, with a combined maximum plan benefit of $250 every year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H0028-019 (HMO) plan covers dental services, including oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, and other preventive dental services with no copay. The plan also covers restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay, but prosthodontics (removable and fixed) have a 30% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0028-019 (HMO) plan, but require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment is covered under the Humana Gold Plus H0028-019 (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $325, Therapeutic Radiological Services have a coinsurance of at least 20% and a copay up to $30, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-019 (HMO) plan with no copay and no coinsurance. However, 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 Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and there is a copay for some services, but the specific amount is not detailed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H0028-019 (HMO) plan. For days 1-20, the copay is $20, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture with a $25 copay, and over-the-counter items with a maximum benefit of $100 every three months. Meal benefits are covered with no copay. However, 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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