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Humana Gold Plus H0028-037 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-037 (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 H0028-037 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-037 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Austin 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 H0028-037 (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 H0028-037 (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 H0028-037 (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. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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 $4850.00 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 H0028-037 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, you will pay no copay for preferred generic drugs at a standard pharmacy or through preferred mail order, but $20 copay for standard mail order. For preferred brand drugs, you'll pay 35% coinsurance at preferred pharmacies and 45% coinsurance through standard mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H0028-037 (HMO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary depending on the service. Emergency and urgent care services are covered with copays, and transportation to health-related locations is available. This plan includes coverage for primary care, preventive services, hearing, vision, and dental services, often with no copay or a low copay. The plan also covers home health, skilled nursing, and dialysis services, along with other services like acupuncture. Some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor referral. For days 1-6, there is a $275 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay of $0-$260, observation services with a copay of $275, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a copay of $30-$50 for individual and group sessions, and outpatient blood services with no copay. Prior authorization and a doctor referral are required for several of these services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $45 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground ambulance, air ambulance, and transportation services to plan-approved health-related locations. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations have no copay, and offer up to 24 one-way trips per year using a 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 by Humana Gold Plus H0028-037 (HMO). Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The Humana Gold Plus H0028-037 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and specialist services with a $30 copay. Mental health, psychiatric, and other health care professional services have varying copays, and routine chiropractic care and podiatry services are not covered. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a copay between $0 and $55. Opioid treatment program services have a copay between $30 and $50.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and additional preventive services, and have no coinsurance. Annual physical exams have no copay, while other preventive services may have a copay. Additional services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services includes hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999, but prescription hearing aids for the 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 H0028-037 (HMO) plan covers vision services, including routine eye exams with a copay of $0 - $30 and eyewear with a combined maximum plan benefit of $150 per year. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H0028-037 (HMO) plan covers dental services, including Medicare dental services with a $30 copay, and other dental services with an annual maximum of $2,000. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered, and orthodontics is covered under the Diagnostic and Preventive Dental (16b) benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H0028-037 (HMO) plan, including Insulin and Medicare Part B drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-037 (HMO) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $60, and Lab Services with no copay. Radiological Services are also covered, including Diagnostic Radiological Services with a copay up to $325, Therapeutic Radiological Services with a copay up to $30 and 20% coinsurance, and Outpatient X-Ray Services with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-037 (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 with prior authorization and a doctor's referral. However, none of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H0028-037 (HMO) plan, requiring prior authorization and a doctor's referral. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes acupuncture, covered at a $30 copay, and meal benefits with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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