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Humana Gold Plus SNP-DE H0028-033 (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 H0028-033 (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 H0028-033 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Houston 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 SNP-DE H0028-033 (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 H0028-033 (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 H0028-033 (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 H0028-033 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.90. 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 H0028-033 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly Part D premium is $10.90. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, and outpatient services with 20% coinsurance. The plan also includes no copay for preventive services like annual physical exams, and covers dental services with a $3,000 annual maximum. Additional benefits include coverage for hearing and vision services, as well as home infusion and dialysis services, all with varying cost-sharing. The plan provides transportation, emergency services, and skilled nursing facility coverage, along with other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP) plan. For Inpatient Hospital-Acute, there is a $2100 copay per admission or stay. For Inpatient Hospital Psychiatric, there is a $2036 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stay 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 Hospital Services, Observation Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse all have a 20% coinsurance. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization, and requires a 20% coinsurance.
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 plan-approved health-related locations are covered with no copay, up to 48 one-way trips per year, with the mode of transportation being taxi, bus/subway, or medical transport.
Emergency Services See details
Emergency Services are covered by the Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP) plan with a $110 copay, and 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 H0028-033 (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, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. 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 and speech-language pathology services, additional telehealth benefits, and opioid treatment program services have a 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP) plan covers preventive services, including annual physical exams with no copay, and kidney disease education with no copay. Other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, are covered with no copay. However, additional preventive services like health education, in-home safety assessments, and others 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 hearing aid fitting/evaluation, though the exact copay amount is not specified. Prescription hearing aids are covered up to $1,000 every three years, and OTC hearing aids are covered with no copay.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance and no copay. Eyewear benefits are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered. Contact lenses and eyeglasses (lenses and frames) have no copay, and there is a combined maximum of $250 per year for all eyewear.
Dental Services See details
The Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP) plan covers Medicare Dental Services with 20% coinsurance, and other dental services with a $3,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP) plan. Prior authorization is required, and you will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. 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, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of up to 20%, and Lab Services have no copay and a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but 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 H0028-033 (HMO D-SNP) plan. This includes 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, with no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP) plan covers acupuncture with a 20% coinsurance and requires prior authorization, and also covers Over-the-Counter (OTC) items up to $1200 per year. The plan also covers a meal benefit with no copay and requires prior authorization, but does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and other services.
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