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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 2025, 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 Select Counties in Texas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-041 (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 $4.00. 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 $200.00 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 $4200.00 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) plan has a $200 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. For preferred generic drugs, the copay is $5.00 at a standard or preferred mail pharmacy and $20.00 at a standard mail pharmacy. For standard generic drugs, the copay is $45.00 at a standard or preferred mail pharmacy and $47.00 at a standard mail pharmacy. Preferred brand drugs have a 46% coinsurance, and non-preferred drugs have a 30% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H0028-041 (HMO) plan offers comprehensive coverage with a range of benefits. Inpatient hospital stays have a $275 copay for the first five days, and then no copay. The plan covers a variety of outpatient services with copays ranging from $0 to $240, including primary care, specialist visits, and mental health services. Preventive services, hearing, vision, and dental care are included, with many services having no copay. Emergency services have a $125 copay, while ambulance services have a copay or coinsurance depending on the service. The plan provides additional benefits like home health services, and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you pay a $275 copay for days 1-5, and no copay for days 6-90. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $240, Observation Services with a $275 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a copay between $30 and $50 for individual or group sessions. Outpatient Blood Services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H0028-041 (HMO) plan, with a $45 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H0028-041 (HMO). Ground ambulance services have a $315 copay, while air ambulance services have 20% coinsurance. Transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the Humana Gold Plus H0028-041 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $55 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $125 copay.
Primary Care See details
The Humana Gold Plus H0028-041 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services and physical therapy and speech-language pathology services with a $20 and $25 copay respectively. The plan also covers mental health specialty services, psychiatric services, additional telehealth benefits, and opioid treatment program services with varying copays. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services and additional services, like an annual physical exam with no copay. Other preventive services, including Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit, are covered with no copay.
Hearing Services See details
The Humana Gold Plus H0028-041 (HMO) plan covers hearing exams with a $20 copay, and routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are partially covered, with Prescription Hearing Aids (all types) having a copay between $99 and $699, while other types are not covered. OTC hearing aids are covered with a maximum benefit of $90 every three months.
Vision Services See details
The Humana Gold Plus H0028-041 (HMO) plan covers vision services, including routine eye exams with a copay of $0-$20, and eyewear. Eyewear includes contact lenses and eyeglasses (lenses and frames) with no copay, and a combined maximum plan benefit of $300 every year. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $3,000 annual maximum benefit. Medicare dental services have a $20 copay. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services, all with no copay, as well as restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0028-041 (HMO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefit, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a 20% coinsurance, and Diabetic Equipment. 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 include coverage for all diagnostic services, with a copay ranging from $0 to $60, and lab services with no copay. Radiological Services include coverage for diagnostic radiological services with a copay of at most $325, therapeutic radiological services with a coinsurance of at most 20% and a copay of at most $20, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H0028-041 (HMO) with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus H0028-041 (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H0028-041 (HMO) plan, with a $10 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H0028-041 (HMO) plan covers acupuncture with a $20 copay and over-the-counter items, including nicotine replacement therapy and naloxone, with a maximum benefit of $90 every three months. This plan also covers a meal benefit with no copay. Other services such as 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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