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Humana Gold Plus H0028-028 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-028 (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 H0028-028 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-028 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Maricopa and Yavapai 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 H0028-028 (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 H0028-028 (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 H0028-028 (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 $2.00. 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 $225.00 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 $5570.00 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 H0028-028 (HMO) plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $225.00. If you qualify for the low-income subsidy, also known as Extra Help, your drug costs are reduced to no cost. After meeting your deductible, you will pay copayments or coinsurance for your medications during the initial coverage phase until your total drug costs reach $2,100.00. During this initial phase, a 30-day supply of Tier 1 preferred generics has a $5.00 copay at standard pharmacies and preferred mail, while Tier 2 standard generics cost a $47.00 copay. Tier 3 preferred brands require a 42% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescription drugs.
Additional Benefits
The Humana Gold Plus H0028-028 (HMO) plan offers comprehensive medical coverage featuring no copay for primary care visits, routine annual physicals, and home health services. For specialized care, specialist visits require a copay ranging from $15 to $45, while inpatient hospital stays require a $375 daily copay for the first six days and no copay for days seven through ninety. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes valuable dental, vision, and hearing benefits, featuring no copay for routine eye exams, routine hearing exams, and preventive dental services. Prescription hearing aids require a copay between $599 and $899, while covered eyewear is covered with no copay up to a $100 annual limit. Additionally, durable medical equipment and prosthetic devices are covered with no copay and a 15% to 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H0028-028 (HMO) partially covers inpatient hospital benefits, requiring a $375 daily copay for days 1 to 6 and no copay for days 7 to 90, with no coinsurance for covered stays. While unlimited additional acute hospital days are covered with no copay, non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H0028-028 (HMO) covers outpatient services with no coinsurance, though prior authorization is required for most services. Copays range from $0 to $400 for outpatient hospital services, $375 per stay for observation services, and $25 to $35 for outpatient substance abuse sessions, while ambulatory surgical center and blood services have no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Gold Plus H0028-028 (HMO) for a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Humana Gold Plus H0028-028 (HMO) plan, which features a $335 copay for ground ambulance services and a $630 copay for air ambulance services, with no coinsurance required for either. However, additional transportation services to health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H0028-028 (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 require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Primary care and professional services are covered by Humana Gold Plus H0028-028 (HMO) with no copay and no coinsurance for primary care visits, and copays ranging from $15 to $45 with no coinsurance for specialists and therapies. Chiropractic services are partially covered with a $15 copay and no coinsurance, as routine chiropractic care is not covered.
Preventive Services See details
Humana Gold Plus H0028-028 (HMO) partially covers preventive services with no copay or coinsurance for covered benefits like annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, memory fitness, and chemotherapy-related wigs. However, multiple supplemental services are not covered under this plan, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus H0028-028 (HMO), offering routine hearing exams and fitting evaluations with no copay, Medicare-covered exams for a $35 copay, and prescription hearing aids with a $599 to $899 copay, all with no coinsurance or deductibles. OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H0028-028 (HMO) partially covers vision services with no coinsurance or deductible, offering one annual routine eye exam with no copay and other eye exams for a copay of $0 to $35. Covered eyewear, including contact lenses and complete eyeglasses (lenses and frames), has no copay up to a $100 annual limit, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-028 (HMO) offers partially covered dental services with a $750 annual limit, excluding fluoride treatment, maxillofacial prosthetics, implants, and orthodontics. Medicare dental services require a $35 copay and no coinsurance, while covered preventive and most basic services have no copay and no coinsurance. Restorative and prosthodontic services require no copay and a 30% to 40% coinsurance.
Home Infusion bundled Services See details
Humana Gold Plus H0028-028 (HMO) covers home infusion bundled services with prior authorization, requiring no copay and no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H0028-028 (HMO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H0028-028 (HMO), including durable medical equipment (DME) for a 15% coinsurance and no copay, and prosthetic devices for a 20% coinsurance and no copay. Medical supplies require a 15% coinsurance and no copay, diabetic supplies carry a 10% to 20% coinsurance and no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-028 (HMO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance. Diagnostic tests require a $0 to $100 copay with no coinsurance, diagnostic radiology has a $0 to $300 copay with no coinsurance, outpatient X-rays have no copay but require coinsurance, and therapeutic radiology requires a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H0028-028 (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-028 (HMO) does not cover Cardiac Rehabilitation Services. This non-coverage extends to all related sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-028 (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100, with no coinsurance. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Humana Gold Plus H0028-028 (HMO), as over-the-counter (OTC) items and dual eligible SNPs are not covered. Covered acupuncture services require a $35 copay and no coinsurance, while the meal benefit is covered with no copay and no coinsurance.
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