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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 2026, 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 Northeast Texas and Austin Metro. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $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 $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 $9250.00 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) Medicare plan has an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay when using standard pharmacies or preferred mail order for both 1-month and 3-month supplies. However, standard mail order options require a copay of $10 to $30 for Tier 1 and $20 to $60 for Tier 2 medications depending on the supply duration. Higher-tier medications under this plan transition to a coinsurance model instead of flat copayments. Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all require a 25% coinsurance. This 25% coinsurance applies across standard pharmacies, preferred mail order, and standard mail order for all available supply lengths.
Additional Benefits
The Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) offers robust medical coverage with many essential services requiring no copay, though coinsurance and prior authorizations frequently apply. For hospital care, inpatient stays require no coinsurance but carry a copay of $2,230 for acute care or $1,850 for psychiatric care, while outpatient services generally feature no copay and a 20% coinsurance. Emergency room visits have a $115 copay with no coinsurance, and primary care, specialist, and diagnostic services are covered with no copay and a 20% coinsurance. This plan also provides excellent supplemental benefits to help manage your daily health needs at minimal out-of-pocket costs. Preventive care, home health services, and up to 60 routine one-way transportation trips are fully covered with no copay and no coinsurance. Additionally, routine dental services are covered with no copay and no coinsurance up to a $5,000 annual limit, while routine vision and hearing exams feature no copay and a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and an $1,850 copay per stay for psychiatric care. Prior authorization and referrals are required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization and referrals are required for most of these covered outpatient medical services.
Partial Hospitalization See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) provides partially covered ambulance and transportation services, both of which require prior authorization. Ground and air ambulance services are covered with a 20% coinsurance and no copay, while up to 60 one-way trips per year to plan-approved locations are covered with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) covers primary care, specialist, mental health, psychiatric, therapy, telehealth, and opioid treatment services with no copay and a 20% coinsurance. Podiatry services are not covered, and chiropractic services are only partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance while excluding other chiropractic services.
Preventive Services See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) covers preventive services with no copay and no coinsurance, including annual physicals, kidney disease education, and other routine screenings. The additional preventive services benefit is partially covered, as a memory fitness benefit is included, but sub-services such as health education, in-home safety assessments, personal emergency response systems, and nutritional benefits are not covered.
Hearing Services See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) hearing services include one routine hearing exam per year with no copay and 20% coinsurance, and unlimited hearing aid fittings with no copay. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two aids every three years, excluding inner ear, outer ear, and over the ear models. Over-the-counter hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP), offering one annual routine eye exam with no copay, 20% coinsurance, and no deductible, while other eye exams are not covered. Covered eyewear has no copay, no coinsurance, and no deductible up to a $300 annual limit for one pair of eyeglasses or contact lenses, though separate eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) partially covers dental services up to a $5,000 annual limit, featuring no copay and no coinsurance for covered preventive and comprehensive services. Medicare-covered dental services have a 20% coinsurance and no copay, while fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) and require prior authorization and step therapy. Medicare Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance, while other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Both prior authorization and a referral are required for these services.
Medical Equipment See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with a 20% coinsurance and no copay. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) covers diagnostic and radiological services, requiring prior authorization and referrals for all covered services. Diagnostic procedures, lab services, and radiological services all carry a 20% coinsurance, with no copay for lab and radiological services, though diagnostic procedures and tests require a copayment.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) plan with no copay and no coinsurance. Please note that both a referral and prior authorization are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are partially covered by Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) with no copay, but intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation are not covered and require a 20% coinsurance. Covered services also require prior authorization and a referral from your doctor.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required, a prior three-day hospital stay is not needed, and additional days beyond 100 days are not covered.
Other Services See details
Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) covers acupuncture with no copay and 20% coinsurance for up to 20 treatments per year, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while highly integrated services and other auxiliary services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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