A non-government entity
Humana Gold Plus H0028-042 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-042 (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 H0028-042 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-042 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Houston Metro 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 H0028-042 (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 H0028-042 (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 H0028-042 (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 $340.00 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 $3450.00 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 H0028-042 (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 H0028-042 (HMO) prescription drug plan has an annual drug deductible of $340. For Tier 1 preferred generic drugs, there is no copay at standard pharmacies or through preferred mail order, though standard mail order costs $10 for a one-month supply. Tier 2 generic drugs carry a $5 copay for a one-month supply at standard pharmacies and preferred mail order, with no copay for a three-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, which increases to a $131 copay for a three-month preferred mail order supply and a $141 copay at standard pharmacies. Tier 4 non-preferred drugs require a 48% coinsurance for both one-month and three-month supplies. For Tier 5 specialty drugs, you will pay a 29% coinsurance for a one-month supply.
Additional Benefits
The Humana Gold Plus H0028-042 (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no deductible and no copay for primary care visits and preventive services. For specialist visits, patients pay a low $20 copay, while inpatient hospital stays require a $150 daily copay for the first five days and no copay for subsequent days. Emergency room visits carry a $150 copay, which is waived if admitted, and urgent care services are available with a $65 copay. This plan also includes valuable supplemental benefits like dental coverage up to $2,000 annually with no copay for preventive care, and vision coverage featuring no copay for routine exams plus up to $350 yearly for eyewear. Additionally, members can access hearing exams for a copay of up to $20, alongside covered home health services, acupuncture, and over-the-counter items at no copay. Most of these additional benefits require no coinsurance, making healthcare costs highly manageable.
Inpatient Hospital See details
Humana Gold Plus H0028-042 (HMO) covers inpatient hospital services with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because unlimited additional acute care days are covered at no copay, whereas additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H0028-042 (HMO) covers outpatient hospital services with no coinsurance and a copay of $0 to $200, plus a $150 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services carry a $20 to $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H0028-042 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-042 (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, offering up to 60 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H0028-042 (HMO) covers emergency room visits with a $150 copay (waived if admitted within 24 hours) and urgent care with a $65 copay, with no coinsurance required for either service. Worldwide emergency, urgent, and transportation services are also covered under the plan with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-042 (HMO) covers primary care physician visits with no copay and no coinsurance, while specialist, therapy, and mental health services require a $20 copay and no coinsurance. Some chiropractic services are covered, though routine and other chiropractic services are not covered, and podiatry is not covered. Telehealth services feature a $0 to $65 copay and opioid treatment has a $20 to $35 copay, both with no coinsurance.
Preventive Services See details
Humana Gold Plus H0028-042 (HMO) covers preventive services, including annual physicals, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are partially covered; memory fitness is included with no copay and no coinsurance, but services such as health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access, bathroom modifications, and counseling are not covered.
Hearing Services See details
Hearing services covered by the Humana Gold Plus H0028-042 (HMO) plan include hearing exams with no coinsurance and copays up to $20, as well as unlimited OTC hearing aids with no copay or 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
Humana Gold Plus H0028-042 (HMO) partially covers vision services with no deductibles, no coinsurance, and no copays for one routine eye exam and up to $350 annually for eyewear. Covered eyewear options include one pair of contact lenses or one set of eyeglasses (lenses and frames) per year, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-042 (HMO) partially covers dental services with a $2,000 annual limit, requiring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered diagnostic, preventive, and restorative services. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-042 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H0028-042 (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H0028-042 (HMO), with durable medical equipment, prosthetics, and medical supplies requiring a 20% coinsurance and no copay. Diabetic supplies feature a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-042 (HMO) covers diagnostic and radiological services with prior authorization required, offering no copay for lab services, outpatient X-rays, and diagnostic radiological services. Diagnostic procedures and tests carry no coinsurance with copays ranging from $0 to $150, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $20 copay.
Home Health Services See details
Humana Gold Plus H0028-042 (HMO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-042 (HMO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a $20 copay.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-042 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H0028-042 (HMO) partially covers other services with no copay and no coinsurance, including up to 12 acupuncture treatments per year, over-the-counter items, and meal benefits for chronic illnesses. Other miscellaneous services and Dual Eligible SNPs 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