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Humana Gold Plus H0028-030 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-030 (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 H0028-030 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-030 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in San Antonio Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-030 (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 H0028-030 (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 H0028-030 (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 $1.00. 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 $615.00 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 $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 H0028-030 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for one-month or three-month supplies when using standard pharmacies or preferred mail order. Standard mail order fills for these generic tiers require copays ranging from $10 to $60 depending on the tier and supply length. Tier 3 preferred brand drugs require a $45 copay for a one-month supply at standard pharmacies and preferred mail order, or $47 through standard mail order. Tier 4 non-preferred drugs are subject to a 46% coinsurance across all standard pharmacy and mail order channels. Specialty medications in Tier 5 carry a 25% coinsurance for a one-month supply.
Additional Benefits
The Humana Gold Plus H0028-030 (HMO) plan offers affordable medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $15 copay, while inpatient hospital stays cost a $95 daily copay for the first five days followed by no copay. Emergency care is available with a $150 copay, which is waived if you are admitted, and urgent care requires a $65 copay. Members also benefit from extensive dental, vision, and hearing coverage, including no copay for routine eye exams, dental cleanings up to a $4,000 annual limit, and routine hearing evaluations. Vision hardware is covered with no copay up to a $300 yearly limit, while prescription hearing aids require a copay of $499 to $1,099. Most diagnostic lab work and home infusion services feature no copay, while durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H0028-030 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $95 per day for days 1 through 5, followed by no copay for days 6 through 90. Additional acute hospital days are fully covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H0028-030 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $100 ($95 per stay for observation services), while individual and group outpatient substance abuse sessions carry a copay of $20 to $35 with no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H0028-030 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-030 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved health locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H0028-030 (HMO) covers emergency services with a $150 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $65 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-030 (HMO) features primary care physician visits with no copay and no coinsurance, and specialist visits for a $15 copay and no coinsurance. Additional covered services, such as physical, occupational, and mental health therapies, have copays ranging from $20 to $35 with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H0028-030 (HMO) covers preventive services—including annual physicals, kidney disease education, and memory fitness—with no copay and no coinsurance. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary services, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus H0028-030 (HMO) hearing services are covered with no deductible and no coinsurance, featuring a $15 copay for Medicare-covered exams and no copay for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with a copay of $499 to $1,099 for up to two aids per year, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Gold Plus H0028-030 (HMO) provides partially covered vision services with no deductible, no coinsurance, and copays ranging from $0 to $15. Covered benefits include annual routine eye exams and eyeglasses or contact lenses with no copay up to a $300 yearly limit, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-030 (HMO) partially covers dental services up to a $4,000 annual limit, offering most preventive and comprehensive services with no copay and no coinsurance, while Medicare-covered dental services require a $15 copay and no coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-030 (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H0028-030 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
Humana Gold Plus H0028-030 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies feature a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-030 (HMO) covers diagnostic and radiological services, with prior authorization and referrals required. Diagnostic services feature no coinsurance, with no copay for lab work and a $0 to $75 copay for procedures, while radiological services range from no copay for X-rays to a minimum 20% coinsurance and $20 copay for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H0028-030 (HMO) with no copay and no coinsurance. Please note that both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus H0028-030 (HMO) plan with no copay and no coinsurance, requiring prior authorization and a referral. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-030 (HMO) covers skilled nursing facility (SNF) care with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, though a prior three-day inpatient hospital stay is not necessary, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Humana Gold Plus H0028-030 (HMO) partially covers other services, offering acupuncture for a $15 copay and no coinsurance for up to 20 yearly treatments, and chronic illness meals with no copay and no coinsurance, both requiring prior authorization. Over-the-counter item reimbursements are also covered with no copay and no coinsurance, though some CMS OTC list drugs and other miscellaneous services are not covered.
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