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Humana Gold Plus H0028-021 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-021 (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 H0028-021 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-021 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Pima and Pinal Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-021 (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 H0028-021 (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 H0028-021 (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 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 $4200.00 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 H0028-021 (HMO) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $250.00. During the initial coverage phase, Tier 1 preferred generics cost an $8.00 copay at standard pharmacies and preferred mail, or a $20.00 copay via standard mail. Tier 2 standard generics carry a $47.00 copay, while Tier 3 preferred brands and Tier 4 non-preferred drugs require 39% and 30% coinsurance, respectively. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will have no copay for Medicare Part D covered drugs. Additionally, those who qualify for the low-income subsidy will benefit from a premium reduction, resulting in no copay for their Part D coverage.
Additional Benefits
The Humana Gold Plus H0028-021 (HMO) plan offers comprehensive coverage for essential medical needs, featuring no copay and no coinsurance for primary care doctor visits, preventive services, and home health care. For specialist visits, members will pay a $25 copay, while emergency room visits carry a $130 copay and urgent care is covered with a $50 copay. Inpatient hospital stays require a $320 daily copay for the first seven days, after which there is no copay for days 8 through 90. Routine dental cleanings, preventive exams, and select eyewear are available with no copay, while basic hearing and vision exams feature low copays of up to $25. Outpatient surgical services also feature no copay, whereas advanced medical equipment like durable medical equipment requires a 15% coinsurance with no copay. Dialysis care is covered with a 20% coinsurance and no copay, ensuring affordable access to critical ongoing treatments.
Inpatient Hospital See details
Humana Gold Plus H0028-021 (HMO) partially covers inpatient hospital benefits with a daily copay of $320 for days 1 through 7, no copay for days 8 through 90, and no coinsurance for both acute and psychiatric stays. While unlimited additional acute care days are covered at no copay, this plan does not cover upgrades, non-Medicare-covered stays, or additional psychiatric days.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H0028-021 (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Other covered benefits require copayments, including $0 to $310 for outpatient hospital services, $320 per stay for observation services, and $25 to $35 for outpatient substance abuse sessions.
Partial Hospitalization See details
Humana Gold Plus H0028-021 (HMO) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-021 (HMO) partially covers ambulance and transportation services, as transportation services to health-related locations are not covered. Covered ground ambulance services require a $335 copay and air ambulance services require a $630 copay, both with no coinsurance.
Emergency Services See details
Humana Gold Plus H0028-021 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-021 (HMO) offers primary care physician visits with no copay and no coinsurance, while specialist visits require a $25 copay and therapy services require a $35 copay with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine chiropractic care, and other benefits like telehealth, podiatry, and mental health sessions are covered with copays ranging from no copay up to $50 with no coinsurance.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus H0028-021 (HMO) with no copay and no coinsurance for covered benefits such as annual physicals, glaucoma screenings, and diabetes training. Supplemental services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, and caregiver support.
Hearing Services See details
Humana Gold Plus H0028-021 (HMO) covers hearing exams with a $25 copay and OTC hearing aids with no copay, both featuring no coinsurance. Prescription hearing aids are partially covered, offering select types for a $699 to $999 copay and no coinsurance, while inner ear, outer ear, and over-the-ear devices are not covered.
Vision Services See details
Humana Gold Plus H0028-021 (HMO) provides partially covered vision services, featuring eye exams with a $0 to $25 copay and eyewear with no copay, both with no coinsurance. While contact lenses and eyeglasses are covered up to a $250 annual maximum, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-021 (HMO) partially covers dental services, offering preventive care like exams and cleanings with no copay and no coinsurance, alongside Medicare-covered dental services for a $25 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered, though optional supplemental benefits like restorative and endodontic care are available for an additional fee.
Home Infusion bundled Services See details
Humana Gold Plus H0028-021 (HMO) covers home infusion bundled services, which require prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H0028-021 (HMO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H0028-021 (HMO), including durable medical equipment (DME), prosthetics, and diabetic equipment, with prior authorization required for most items. DME and medical supplies require a 15% coinsurance with no copay, while prosthetics have a 20% coinsurance with no copay. Diabetic supplies carry a 10% to 20% coinsurance with no copay, and therapeutic shoes or inserts have a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-021 (HMO) covers diagnostic and radiological services with prior authorization, featuring no copay or coinsurance for lab services and outpatient X-rays. Diagnostic procedures have a copay of $0 to $150 with no coinsurance, while diagnostic radiological services require a copay of up to $300 with no coinsurance. Therapeutic radiological services are covered with a 20% coinsurance and no copay.
Home Health Services See details
Humana Gold Plus H0028-021 (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H0028-021 (HMO) plan. This includes no coverage for intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Humana Gold Plus H0028-021 (HMO), requiring a daily copay of $10 for days 1 to 20 and $218 for days 21 to 100, with no coinsurance. Prior authorization is required, and while a three-day prior hospital stay is not required, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Humana Gold Plus H0028-021 (HMO), excluding Dual Eligible SNPs with Highly Integrated Services. Covered benefits include acupuncture for a $25 copay and no coinsurance, alongside over-the-counter items and meal benefits with no copay and no coinsurance.
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