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Humana Gold Plus H0028-041 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-041 (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 H0028-041 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-041 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in East Texas. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-041 (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 H0028-041 (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 H0028-041 (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 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 $4250.00 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 H0028-041 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications are also highly affordable, requiring no copay for a 3-month supply through preferred mail order and a low $5 copay for a 1-month supply. Tier 3 preferred brand drugs have a copay of $45 for a 1-month supply at standard pharmacies and through preferred mail order. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 49% coinsurance. Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply across standard pharmacies, preferred mail order, and standard mail order options.
Additional Benefits
The Humana Gold Plus H0028-041 (HMO) plan offers affordable healthcare coverage with no copay for primary care doctor visits and a low $20 copay for specialists. Inpatient hospital stays require a $275 daily copay for the first five days and no copay for days six through 90, while emergency room visits carry a $130 copay. Outpatient services feature no copay for ambulatory surgical centers, though outpatient hospital services can range from no copay up to a $240 copay. This plan also includes comprehensive supplemental benefits, featuring preventive and comprehensive dental care with no copay up to a $2,500 annual limit. Members enjoy no copay for routine hearing exams and OTC hearing aids, alongside a $350 annual allowance for eyewear with no copay. Additionally, routine transportation up to 60 one-way trips, home health services, acupuncture, and meal benefits are all covered with no copay.
Inpatient Hospital See details
Humana Gold Plus H0028-041 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $275 copayment per day for days 1 to 5 and no copayment for days 6 to 90. Unlimited additional acute hospital days are covered with no copayment, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H0028-041 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $240, observation services carry a $275 copay per stay, and outpatient substance abuse sessions have a copay of $20 to $35.
Partial Hospitalization See details
Humana Gold Plus H0028-041 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-041 (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 60 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 H0028-041 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay 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 transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-041 (HMO) primary care benefits feature primary care physician visits with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Physical, occupational, and speech therapies require a $25 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H0028-041 (HMO) provides partial coverage for preventive services, offering covered benefits like annual physical exams, kidney disease education, and memory fitness with no copay and no coinsurance. However, several supplemental benefits are not covered, including health education, in-home safety assessments, personal emergency response systems (PERS), and weight management programs.
Hearing Services See details
Humana Gold Plus H0028-041 (HMO) covers hearing services, providing routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams have a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $99 to $399, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H0028-041 (HMO) offers partially covered vision services with no coinsurance, featuring a $0 to $20 copay for eye exams and no copay for eyewear up to a $350 annual limit. While routine annual eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-041 (HMO) offers partially covered dental services with a $2,500 annual maximum, requiring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive dental care. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-041 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus H0028-041 (HMO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Humana Gold Plus H0028-041 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic equipment and supplies are also covered with a 10% to 20% coinsurance and copays ranging from no copay up to $10.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-041 (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic services have no coinsurance, featuring no copay for lab services and a $0 to $50 copay for procedures, while radiological services range from no copay for diagnostic radiology and X-rays to a minimum 20% coinsurance and $20 copay for therapeutic radiology.
Home Health Services See details
Humana Gold Plus H0028-041 (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-041 (HMO) offers cardiac rehabilitation services with no coinsurance and prior authorization required. While some services are covered, standard cardiac rehabilitation (with a $20 copay), intensive cardiac rehabilitation (with a $20 copay), pulmonary rehabilitation (with a $15 copay), and supervised exercise therapy for peripheral artery disease (with a $15 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-041 (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 to 20 and $218 for days 21 to 100. Prior authorization is required and a prior three-day hospital stay is not, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H0028-041 (HMO) provides coverage for select other services, including acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while Dual Eligible SNPs with Highly Integrated Services and other miscellaneous services are not covered.
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