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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 2025, 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 2025.
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 $3.00. 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 $3900.00 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 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, you will pay a $10 copay for preferred generic drugs at a preferred pharmacy and 41% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H0028-021 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay for the first 7 days, while outpatient services have copays depending on the service. Emergency, primary care, and preventive services are covered, often with no copay. This plan also provides coverage for hearing, vision, and dental services. Hearing exams, routine vision exams, and many dental services have no copays. Additionally, the plan includes coverage for ambulance, home health, and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered under this plan. For the first 7 days of an inpatient stay, you will pay a $340 copay, and for days 8-90, there is no copay; additional days for acute inpatient hospital are covered with no copay, while all other additional services are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $340, observation services with a $340 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $50 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan. You will pay a $100 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0028-021 (HMO) plan, with no coinsurance for ambulance services. Medicare-covered ground ambulance services have a $315 copay, while Medicare-covered air ambulance services have a $630 copay. 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 H0028-021 (HMO) plan. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $55 copay and no coinsurance, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus H0028-021 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $50 copay. This plan also covers physician specialist services with a $30 copay, and mental health specialty services with a $50 copay for individual and group sessions. Podiatry services have a $30 copay, other health care professional services have a copay between $0 and $30, psychiatric services have a $50 copay for individual and group sessions, physical therapy and speech-language pathology services have a $50 copay, additional telehealth benefits have a copay between $0 and $55, and Opioid Treatment Program Services have a $50 copay.
Preventive Services See details
Preventive Services, including Annual Physical Exams, are covered with no copay. Other services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay. Additional preventive services require prior authorization.
Hearing Services See details
Hearing exams are covered with a $30 copay. Routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, but prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered, while prescription hearing aids (all types) have a copay between $699 and $999. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H0028-021 (HMO) plan covers vision services, including routine eye exams with a copay of $0-$30, and eyewear with a $0 copay and a combined maximum of $100 per year for contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, and Adjunctive General Services with no copay. Fluoride Treatment, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, 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 with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance may apply. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance may apply.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-021 (HMO) plan. This benefit requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus H0028-021 (HMO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies also have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $340, and Therapeutic Radiological Services have at least 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-021 (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 covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and there is a copay for some services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H0028-021 (HMO) plan, with a copay of $20 for days 1-20 and $214 for days 21-100, and no coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $30 copay and a limit of 20 treatments 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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