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Humana Gold Plus H0028-025 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-025 (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 H0028-025 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-025 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Colorado. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-025 (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 H0028-025 (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 H0028-025 (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 $4900.00 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 H0028-025 (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $10 copay for a 30-day supply of a preferred generic drug at a standard pharmacy, or 50% coinsurance for a preferred brand drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus H0028-025 (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and emergency care. Primary care visits have no copay, and you'll also find coverage for vision, hearing, and dental services with varying copays. This plan covers home health services and skilled nursing facilities. There are also additional benefits like acupuncture and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-6, the copay is $310, and for days 7-90, there is no copay; additional days for inpatient hospital acute care have no copay for days 91-999.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay ranging from $0 to $310, observation services with a $310 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $35 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0028-025 (HMO) plan with a $100 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0028-025 (HMO) plan. Medicare-covered Ground Ambulance Services have a $315 copay, and Medicare-covered Air Ambulance Services have a $630 copay, but there is no coinsurance. 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 under the Humana Gold Plus H0028-025 (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The Humana Gold Plus H0028-025 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and mental health specialty services with a $35 copay. The plan also covers other services such as podiatry services, physical therapy, and additional telehealth benefits, with varying copays.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, as well as other services that are covered with a copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $35 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay; prescription hearing aids have a copay between $699 and $999. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$35, and eyewear benefits including contact lenses and eyeglasses (lenses and frames) with a $0 copay and a combined maximum of $250 per year, while eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams have no copay.
Dental Services See details
The Humana Gold Plus H0028-025 (HMO) plan covers dental services, with a $35 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay, while fluoride treatments and orthodontics are not covered. Prosthodontics, removable and fixed, have a 30% coinsurance, and the plan has a $2,500 annual maximum for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0028-025 (HMO) plan and require prior authorization. You are responsible for a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices have a 20% coinsurance and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a coinsurance between 10% and 20%, with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests have a copay between $0 and $55, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325. Therapeutic Radiological Services have a maximum copay of $30 and a minimum coinsurance of 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-025 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered by this plan.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H0028-025 (HMO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H0028-025 (HMO) plan covers acupuncture with a $35 copay and meal benefits with no copay. Other services like over-the-counter items, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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