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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 2026, 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 2026.
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 $1.00. 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 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 $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 features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Standard mail order options for these generic tiers range from a $10 to $20 copay for a 1-month supply. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. This clear cost-sharing structure helps you accurately budget your prescription medication expenses throughout the year.
Additional Benefits
The Humana Gold Plus H0028-037 (HMO) plan offers robust medical coverage featuring no copay for primary care visits, home health services, and routine preventive care. For inpatient hospital stays, members pay a $275 daily copay for days one through six and no copay for days seven through ninety. Specialist visits require a $20 copay, while emergency room visits carry a $130 copay that is waived if you are admitted within 24 hours. This plan also includes comprehensive dental care with no copay up to a $2,000 annual limit, and vision coverage with no copay for eyewear up to a $250 annual allowance. Routine hearing exams and over-the-counter hearing aids are covered with no copay, while prescription hearing aids require copays ranging from $699 to $999. Additionally, members pay a low $10 daily copay for the first twenty days of skilled nursing facility stays and have access to no-copay over-the-counter items.
Inpatient Hospital See details
Humana Gold Plus H0028-037 (HMO) covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H0028-037 (HMO) with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $260 ($275 per stay for observation services), while outpatient substance abuse sessions require a $20 to $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H0028-037 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-037 (HMO) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. Routine transportation is partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H0028-037 (HMO) covers emergency services with a $130 copay and no coinsurance, and this copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and emergency transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-037 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits for a $20 copay and no coinsurance. Therapy services cost a $25 copay with no coinsurance, while podiatry is not covered and chiropractic benefits cover some services but exclude routine and other chiropractic care.
Preventive Services See details
Humana Gold Plus H0028-037 (HMO) offers partially covered preventive services with no copay and no coinsurance for covered benefits, such as annual physical exams, kidney disease education, and select screenings. While a memory fitness benefit is covered with no copay, other supplemental services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H0028-037 (HMO), featuring routine exams and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams require a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H0028-037 (HMO) with no deductible and no coinsurance, featuring a $0 to $20 copay for eye exams and no copay for eyewear up to a $250 annual limit. Covered benefits include annual routine eye exams and eyeglasses or contact lenses, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-037 (HMO) partially covers dental services, offering Medicare-covered dental care for a $20 copay and no coinsurance, and other covered preventive and comprehensive dental services with no copay and no coinsurance up to a $2,000 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-037 (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, have no coinsurance to 20% coinsurance, while covered insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H0028-037 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
Humana Gold Plus H0028-037 (HMO) covers durable medical equipment and prosthetics 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.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-037 (HMO) covers diagnostic and radiological services with prior authorization and referrals required. Lab services, diagnostic radiology, and outpatient X-rays feature no copay, while diagnostic tests have a copay ranging from $0 to $50 with no coinsurance, and therapeutic radiology requires a $20 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H0028-037 (HMO) plan with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-037 (HMO) provides coverage for some Cardiac Rehabilitation Services with no coinsurance, requiring prior authorization and a referral. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, with copayments ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H0028-037 (HMO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H0028-037 (HMO) covers acupuncture with a $20 copay and no coinsurance, limited to 20 treatments annually with prior authorization. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, though prior authorization is required for meals and certain CMS-listed OTC drugs are excluded.
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