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Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Texas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP).
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 SNP-DE H0028-031 (HMO D-SNP), 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 a $570.00 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 $9350.00 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 SNP-DE H0028-031 (HMO D-SNP) plan has a $570 deductible for prescription drugs. After the deductible is met, you will pay varying costs depending on the drug tier and pharmacy type. For preferred generic drugs, you will have no copay at standard pharmacies and mail order pharmacies, but a $20 copay at a standard mail order pharmacy. For other tiers, you will pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) plan offers a range of benefits with varying cost-sharing structures. Inpatient hospital stays have a copay per admission, while outpatient services, partial hospitalization, and ambulance services, as well as primary care and other services, typically have a 20% coinsurance. Emergency services have a copay, while preventive services, such as annual physical exams, and some vision and dental services have no copay. Additional benefits include coverage for hearing aids, with a maximum benefit, and dental services with a $2,500 annual maximum. Home health services have no copay, and skilled nursing facility services have a copay for days 21-100. The plan also covers acupuncture, over-the-counter items, and offers a meal benefit for chronic illness.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. Inpatient Hospital-Acute has a copay of $2185 per admission or stay, while Inpatient Hospital Psychiatric has a copay of $2036 per admission or stay; additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services for Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) include outpatient hospital services and observation services with a 20% coinsurance, ambulatory surgical center services and outpatient substance abuse services with a 20% coinsurance, and outpatient blood services with no copay. These services may require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, with prior authorization required. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, and includes 24 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits have a 20% coinsurance. Occupational therapy services, mental health specialty services, psychiatric services, and opioid treatment program services have a minimum coinsurance of 20% and a maximum coinsurance of 20%. This plan does not cover podiatry services, and routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and kidney disease education services with no copay. Other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are also covered with no copay. Some additional preventive services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% for routine exams, and a copay for fitting/evaluation for hearing aids. Prescription hearing aids have a maximum benefit of $1000 every three years, and OTC hearing aids have a $0 copay, with a maximum benefit of $1000 every three years.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, as well as eyewear benefits with no copay. Eyeglass lenses, eyeglass frames and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $2,500 annual maximum benefit. Medicare dental services have a 20% coinsurance, and oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. Fluoride treatment, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. Other Medicare Part B Drugs have a coinsurance between 0% and 20%, with no copay. Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) plan, but require prior authorization and a doctor's referral. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%. Therapeutic Radiological Services and Outpatient X-Ray Services each have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered 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 not in practice. Prior authorization and a doctor referral are required. There is coinsurance for some services, but the plan does not cover any of the sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) plan, requiring prior authorization and a doctor referral. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) plan covers acupuncture with a 20% coinsurance after prior authorization and a limit of 20 treatments per year. This plan also covers over-the-counter (OTC) items, including nicotine replacement therapy and Naloxone, with a maximum benefit coverage amount of $1200 per year. Additionally, the plan offers a meal benefit for chronic illness with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management, and other services are not covered.
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