A non-government entity
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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3600.00 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:
Sign up for Humana Gold Plus H0028-035 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H0028-035 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays and coinsurance amounts depending on the drug tier and the pharmacy you use. For example, you will pay no copay for preferred generic drugs at a standard pharmacy and a $20 copay at a standard mail pharmacy. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Gold Plus H0028-035 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $95 copay for days 1-5, with no copay for subsequent days. Outpatient services have copays ranging from $0 to $120, and emergency services have a $140 copay. This plan provides coverage for a variety of services, including primary care with no copay, hearing exams with a $20 copay, and vision services like routine eye exams and eyewear with no copay. Dental services, home health services, and preventive services like an annual physical exam are also covered. Ambulance services have a $315 copay for ground transport and 20% coinsurance for air transport.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-5 of Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays, the copay is $95, and there is no copay for days 6-90. Additional days for Inpatient Hospital-Acute have no copay, while 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 Services includes coverage for all outpatient hospital services with a copay between $0 and $120, observation services with a $95 copay, Ambulatory Surgical Center (ASC) Services with no copay, and outpatient substance abuse services. Individual and group outpatient substance abuse sessions have a copay between $20 and $100, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Humana Gold Plus H0028-035 (HMO) with a $20 copay. Prior authorization is required.
Ambulance and Transportation Services See details
The Humana Gold Plus H0028-035 (HMO) plan covers ambulance and transportation services. Ground ambulance services have a copay of $315, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 26 one-way trips per year, but 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 has a $140 copay, Urgently Needed Services has a $65 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
The Humana Gold Plus H0028-035 (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $20 copay, Physician Specialist Services with a $20 copay, Mental Health Specialty Services with a $20 copay, Other Health Care Professional services with a copay between $0 and $20, Psychiatric Services with a $20 copay, Physical Therapy and Speech-Language Pathology Services with a $20 copay, Additional Telehealth Benefits with a copay between $0 and $65, and Opioid Treatment Program Services with a copay between $20 and $100. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services are covered. Additional preventive services include Fitness Benefit, 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, 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 Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription Hearing Aids (all types) have a copay between $699 and $999, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H0028-035 (HMO) plan covers vision services, including routine eye exams with a copay between $0 and $20, and eyewear with no copay, including contact lenses and eyeglasses (lenses and frames) with a combined maximum of $200 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, and other services with a $2,000 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, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance, while the other drugs have a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0028-035 (HMO) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying cost sharing. Diabetic Supplies have a coinsurance between 10-20% and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $325, Therapeutic Radiological Services have a coinsurance of at most 20% and a copay of at most $20, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-035 (HMO) plan 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 by Humana Gold Plus H0028-035 (HMO), but the plan does not specify the copay. However, intensive cardiac rehabilitation services, pulmonary rehabilitation services, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H0028-035 (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is a $20 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered, and non-Medicare-covered stays, are not covered.
Other Services See details
The Humana Gold Plus H0028-035 (HMO) plan covers acupuncture with a $20 copay, and also provides a meal benefit with no copay. Other services like over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and others are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved