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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 2026, 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 2026.
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 $1.00. 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 $3800.00 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, starting at an $8 copay for a 1-month supply at standard pharmacies and featuring no copay for a 3-month supply when using preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply across standard pharmacies and mail order options, with savings available on 3-month preferred mail orders. Higher-tier prescriptions require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 33% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus H0028-019 (HMO) plan offers affordable healthcare coverage with no copay for primary care doctor visits and a $15 copay for specialist visits. Preventive care, home health services, and laboratory tests are also covered with no copays and no coinsurance. For hospital care, inpatient stays require a $325 copay per day for days 1 through 6, followed by no copay for days 7 through 90. This plan also includes comprehensive dental, vision, and hearing benefits, featuring no copays for routine exams and most preventive care. Dental services are covered up to a $2,500 annual limit, while vision benefits include a $250 allowance for select eyewear. Additionally, members can access up to 24 one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Humana Gold Plus H0028-019 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 copay for days 1 through 6 and no copay for days 7 through 90. While unlimited additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H0028-019 (HMO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $325, observation services require a $325 copay per stay, and outpatient substance abuse sessions carry a $25 to $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H0028-019 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-019 (HMO) covers ambulance services with no coinsurance, requiring a $335 copay for ground ambulance and a $630 copay for air ambulance. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H0028-019 (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care services under Humana Gold Plus H0028-019 (HMO) feature no copay and no coinsurance for primary care doctor visits, and a $15 copay with no coinsurance for specialist visits. Physical and occupational therapy require a $30 copay and no coinsurance, mental health services have a $25 copay and no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H0028-019 (HMO) offers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. This benefit is partially covered, as supplemental services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies are not covered.
Hearing Services See details
Humana Gold Plus H0028-019 (HMO) covers hearing services, including Medicare-covered exams for a $15 copay and no coinsurance, alongside routine annual exams, fitting evaluations, and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with copays ranging from $599 to $899 and no coinsurance for up to two devices per year, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Humana Gold Plus H0028-019 (HMO) partially covers vision services with no deductibles, no coinsurance, and eye exam copays ranging from no copay to $15. One routine eye exam and select eyewear, such as contact lenses or eyeglasses, are covered yearly with no copay up to a $250 maximum limit, while other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-019 (HMO) partially covers dental services up to a $2,500 annual limit with no copay and no coinsurance for most preventive and comprehensive care, though Medicare-covered dental requires a $15 copay and no coinsurance, and prosthodontics require a 30% coinsurance and no copay. Fluoride treatment, 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 H0028-019 (HMO) with no copay, subject to prior authorization and step therapy. Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance, while Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H0028-019 (HMO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H0028-019 (HMO), including durable medical equipment (DME) and medical supplies at a 15% coinsurance with no copay, and prosthetic devices at a 20% coinsurance with no copay. Diabetic supplies require a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts have a $10 copay, with prior authorization required for most services.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-019 (HMO) covers diagnostic and radiological services, with prior authorization required for all services. Members pay no copay and no coinsurance for lab services, a $0 to $100 copay with no coinsurance for diagnostic procedures, and a minimum $30 copay and 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Humana Gold Plus H0028-019 (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required. This benefit ensures you can receive necessary medical care in your home at no additional cost.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-019 (HMO) covers some cardiac rehabilitation services with no coinsurance and applicable copayments, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-019 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed before admission, additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus H0028-019 (HMO), including acupuncture with a $15 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Additional services listed as Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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