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Humana Gold Plus SNP-DE H0028-032 (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 H0028-032 (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 H0028-032 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H0028-032 (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 H0028-032 (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 H0028-032 (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 H0028-032 (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 H0028-032 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.70. 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 $590.00 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 H0028-032 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, after which you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your Part D premium is $8.70. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) plan offers a range of benefits, including inpatient hospital stays with a copay, and outpatient services with 20% coinsurance. The plan also covers emergency services with a $110 copay, and primary care services also with 20% coinsurance. Additional benefits include coverage for hearing exams and eyewear, with various cost-sharing options, and dental services with a $4,000 annual maximum benefit. The plan also covers home health services, skilled nursing facilities, and other services like acupuncture and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute with a copay of $2,185 per admission or stay, and Inpatient Hospital Psychiatric with a copay of $2,036 per admission or stay, while additional days and upgrades are not covered. Additional days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center services with a 20% coinsurance. Outpatient substance abuse services, including individual and group sessions, also have a 20% coinsurance. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay and cover up to 60 one-way trips per year via taxi, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay, while Urgently Needed Services has a 20% coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) plan covers primary care physician services, chiropractic services (with prior authorization), occupational therapy services, physician specialist services (with prior authorization), mental health specialty services (with prior authorization), other health care professional services (with prior authorization), psychiatric services (with prior authorization), physical therapy and speech-language pathology services (with prior authorization), additional telehealth benefits, and opioid treatment program services (with prior authorization), all with 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) plan covers preventive services including annual physical exams with no copay. The plan also covers Kidney Disease Education Services and Other Preventive Services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all 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, Fitness Benefit, 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 exams are covered with a coinsurance of at most 20% for routine hearing exams, and a copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription and OTC hearing aids are also covered; prescription hearing aids have a maximum benefit of $1,000 every three years, and OTC hearing aids have a $0 copay.
Vision Services See details
The Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay, and eyewear with a combined maximum benefit of $250 per year and no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $4,000 maximum benefit per year. Medicare dental services have a 20% coinsurance and require prior authorization, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics (fixed) have 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance and no copay. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) plan, but require prior authorization. There is a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance with a $0 copay, while Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, and Lab Services have no copay and a coinsurance of at most 20%. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) plan with no copay and no coinsurance, though Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a 20% coinsurance and requires prior authorization, while the meal benefit has no copay and requires prior authorization. OTC items are covered up to $1200 per year.
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