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Humana Gold Plus H0028-029 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-029 (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 H0028-029 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-029 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Corpus Christi Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-029 (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 H0028-029 (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 H0028-029 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $3400.00 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 H0028-029 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you may pay a $0 copay for preferred generic drugs at a standard pharmacy, or a $20 copay at a standard mail pharmacy. For preferred brand drugs, you pay 35% coinsurance at a standard pharmacy and 50% coinsurance at a standard mail pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Humana Gold Plus H0028-029 (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll find no copays for primary care, routine eye exams, and many dental services, and also no copays for Home Health Services. This plan also includes coverage for hearing, vision, and dental services, along with other services like ambulance, emergency, and skilled nursing facilities, each with specific copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For days 1-5, you will pay a $50 copay, and for days 6-90, you will have no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $125, observation services have a $50 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services have a copay between $20 and $50 for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H0028-029 (HMO) plan, with a $35 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0028-029 (HMO) plan. Ground and Air Ambulance Services have a $315 copay, while Transportation Services to a plan-approved health-related location have no copay, with a limit of 60 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H0028-029 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $65 copay, and there is no coinsurance for any of these services. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $140 copay.
Primary Care See details
The Humana Gold Plus H0028-029 (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, but routine care is not covered. Occupational therapy services have a copay between $20 and $40, and physician specialist services have a $20 copay. Mental health and psychiatric services, including individual and group sessions, have a $20 copay. Physical therapy and speech-language pathology services have a copay between $20 and $40. Additional telehealth benefits are covered with a copay between $0 and $65, and opioid treatment program services have a copay between $20 and $50.
Preventive Services See details
Preventive services include coverage for services such as annual physical exams, with no copay, as well as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. Other preventive services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, 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 with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $699 and $999, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a copay between $0 and $20, while routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses (lenses and frames), are covered with no copay, but eyeglass lenses, frames and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H0028-029 (HMO) plan offers dental services with a maximum benefit of $1500 per year. Medicare Dental Services require prior authorization and have a $20 copay, and other dental services include oral exams, dental x-rays, other diagnostic dental services, cleaning, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics (fixed) with no copay. Fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0028-029 (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Humana Gold Plus H0028-029 (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with no copay and 20% coinsurance. Diabetic Equipment is covered, including Diabetic Supplies with 10-20% coinsurance and no copay and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services are covered. Diagnostic Procedures/Tests have a maximum copay of $65, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325. Therapeutic Radiological Services have a maximum copay of $20 and a minimum coinsurance of 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-029 (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 the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H0028-029 (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, the copay is $20 per day, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture and meal benefits. Acupuncture has a $20 copay and requires prior authorization, with a limit of 20 treatments per year. The plan offers meal benefits with no copay, but it requires prior authorization. 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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