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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 $4.00. 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 $5500.00 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. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H0028-025 (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services with varying copays, and ambulance services. Emergency, primary care, preventive, and home health services are also covered, with copays and coinsurance amounts varying by service. This plan includes additional benefits such as hearing and vision services, dental coverage, and home infusion. The plan also provides coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities, with some services requiring prior authorization and having associated copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered. For days 1-6 of an inpatient hospital stay, there is a $330 copay, and for days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $330, and observation services with a $330 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $50.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0028-025 (HMO) plan, with a $100 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0028-025 (HMO) plan. Ground ambulance services have a $315 copay, while air ambulance services have a $630 copay, and there is no coinsurance for either. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus H0028-025 (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $125 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services and Routine Chiropractic Care have a $20 copay, and Routine Chiropractic Care is limited to 12 visits per year. Occupational Therapy Services have a $45 copay. Physician Specialist Services have a $35 copay. Individual and Group Sessions for Mental Health Specialty Services have a $50 copay. Podiatry Services have a $35 copay. Other Health Care Professional benefits have a copay between $0 and $35. Individual and Group Sessions for Psychiatric Services have a $50 copay. Physical Therapy and Speech-Language Pathology Services have a $45 copay. Additional Telehealth Benefits have a copay between $0 and $55. Opioid Treatment Program Services have a $50 copay.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional services, including Fitness Benefit (Memory Fitness) with no copay. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. However, 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services includes hearing exams with a $35 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids (all types) are covered with a copay between $699 and $999 for two visits per year, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
The Humana Gold Plus H0028-025 (HMO) plan covers vision services, including routine eye exams with a copay of $0 - $35, and eyewear with a $0 copay, up to a combined maximum of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H0028-025 (HMO) plan covers Medicare Dental Services with a $35 copay, Oral Exams with no coinsurance, Dental X-Rays with no coinsurance, Other Diagnostic Dental Services with no coinsurance, Prophylaxis (Cleaning) with no coinsurance, and Other Preventive Dental Services with no coinsurance. This plan does not cover Fluoride Treatment, Endodontics, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, or Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H0028-025 (HMO) plan, but prior authorization is required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, while other Medicare Part B drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-025 (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Humana Gold Plus H0028-025 (HMO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a coinsurance between 10% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and all radiological services, with prior authorization required for both. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $330, and Therapeutic Radiological Services have a coinsurance of at least 20% and a copay of at least $35. 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.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H0028-025 (HMO) plan, with prior authorization required. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H0028-025 (HMO) plan covers acupuncture with a $35 copay, limited to 20 treatments per year, as well as 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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