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Humana Gold Plus H0028-035 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-035 (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 H0028-035 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-035 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in El Paso and Hudspeth counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-035 (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 H0028-035 (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 H0028-035 (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.
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 $3350.00 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 H0028-035 (HMO) prescription drug plan features an annual deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for one-month or three-month supplies filled at standard pharmacies or through preferred mail order. If you utilize standard mail order, Tier 1 drugs have a $10 copay and Tier 2 drugs have a $20 copay for a one-month supply. Tier 3 preferred brand drugs require a $45 copay for a one-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. For higher-tier prescriptions, Tier 4 non-preferred drugs require 35% coinsurance and Tier 5 specialty drugs require 25% coinsurance. These cost-sharing details help you estimate your out-of-pocket expenses when choosing the best pharmacy option for your needs.
Additional Benefits
The Humana Gold Plus H0028-035 (HMO) plan offers robust coverage with no copay for primary care physician visits, preventive services, lab tests, and home health care. For inpatient hospital stays, members pay a $95 daily copay for the first five days and no copay for days six through ninety, all with no coinsurance. Specialist visits and routine dental, vision, and hearing exams are highly affordable, requiring only a $15 copay or no copay at all. Additional perks include no copay for over-the-counter items, home meals, and routine eyewear up to a $300 annual limit, plus dental coverage up to a $2,000 limit. While many outpatient and diagnostic services feature no coinsurance, some specialized benefits like durable medical equipment and dialysis require a 20% coinsurance. This plan successfully balances low copays for everyday wellness with predictable costs for emergency and specialized medical care.
Inpatient Hospital See details
Inpatient hospital services are covered under the Humana Gold Plus H0028-035 (HMO) plan with no coinsurance, requiring a $95 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H0028-035 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which also feature no copayments. Outpatient hospital services have a copay ranging from $0 to $120, observation services require a $95 copay per stay, and outpatient substance abuse sessions have a copay of $20 to $35.
Partial Hospitalization See details
Humana Gold Plus H0028-035 (HMO) covers partial hospitalization with a $35.00 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-035 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H0028-035 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and 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 H0028-035 (HMO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Physical, occupational, and speech therapy, along with mental health and psychiatric services, require a $20 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H0028-035 (HMO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copays and no coinsurance. Additional preventive benefits are only partially covered, as a memory fitness benefit is included with no copay and no coinsurance, but services such as health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Humana Gold Plus H0028-035 (HMO) covers Medicare-covered hearing exams with a $15 copay and no coinsurance, while routine exams, fittings, and OTC hearing aids are offered with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $99 to $399 for up to two devices per year, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H0028-035 (HMO) with no coinsurance, offering routine eye exams and eyewear like eyeglasses or contact lenses with no copay, while other eye exams have a copay of up to $15. A $300 annual limit applies to eyewear, but other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-035 (HMO) dental services are partially covered, featuring Medicare-covered dental care for a $15 copay and no coinsurance, and other covered services with no copay and no coinsurance up to a $2,000 annual limit. While exams, cleanings, and extractions are covered, the plan does not cover fluoride treatments, implants, fixed prosthodontics, maxillofacial prosthetics, or orthodontics.
Home Infusion bundled Services See details
Humana Gold Plus H0028-035 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H0028-035 (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required for this benefit.
Medical Equipment See details
Humana Gold Plus H0028-035 (HMO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H0028-035 (HMO), featuring no copay for lab services and outpatient X-rays, and no coinsurance for diagnostic procedures. Outpatient diagnostic tests have a copay of $0 to $95, while therapeutic radiological services require a minimum 20% coinsurance and a copay starting at $15.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H0028-035 (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-035 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though referrals and prior authorization are required. Patients will pay a copay of $15 for cardiac and intensive cardiac rehabilitation, and $20 for pulmonary rehabilitation and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-035 (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Humana Gold Plus H0028-035 (HMO) provides partial coverage for other services, offering acupuncture limited to 12 treatments per year, over-the-counter items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and certain sub-services, including some CMS OTC list drugs and other miscellaneous services, are not covered.
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