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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 2025, 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 2025.
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 $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 $300.00 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:
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Drug Coverage
The Humana Gold Plus H0028-042 (HMO) plan has a $300 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $12 copay for preferred generic drugs at a standard pharmacy, or 33% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Gold Plus H0028-042 (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays. You'll have no copay for many services, such as preventive services, home health, and lab services. The plan also covers ambulance, emergency, and primary care services, with specific copays for each. Additional benefits include coverage for hearing, vision, and dental services, with copays for exams and services. The plan also covers home infusion, dialysis, medical equipment, and diagnostic services with copays or coinsurance. Note that some services require prior authorization, and some services are not covered, so reviewing the details of the plan is important.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $150 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $150 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999, while non-Medicare covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days, and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $200, and observation services with a $150 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay between $30 and $100 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0028-042 (HMO) plan with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0028-042 (HMO) plan. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 60 one-way trips per year. 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 the Humana Gold Plus H0028-042 (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $65 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
Primary Care benefits for Humana Gold Plus H0028-042 (HMO) include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services (routine care not covered), Occupational Therapy Services and Physician Specialist Services, a $20 copay for Physical Therapy and Speech-Language Pathology Services, $0-$65 copay for Additional Telehealth Benefits, and $30-$100 copay for Opioid Treatment Program Services. Mental Health and Psychiatric Services have a $30 copay for individual and group sessions, and Other Health Care Professional services have a copay between $0 and $20.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services; however, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are covered with no copay.
Hearing Services See details
Hearing exams have a $20 copay, and routine hearing exams are covered with no copay for one visit every year. Fitting/evaluation for hearing aids is covered with no copay, and prescription hearing aids are covered with a copay between $699 and $999 for two visits every year. OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear, are not covered.
Vision Services See details
The Humana Gold Plus H0028-042 (HMO) plan covers vision services, including routine eye exams with a copay of $0-$20 and eyewear with no copay, including contact lenses and eyeglasses (lenses and frames) with a combined maximum plan benefit coverage of $200 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include a $20 copay for Medicare dental services, and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, oral and maxillofacial surgery, and prosthodontics, fixed; however, fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan also covers orthodontic services.
Home Infusion bundled Services See details
The Humana Gold Plus H0028-042 (HMO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance; prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0028-042 (HMO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, is covered. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Gold Plus H0028-042 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $325, Therapeutic Radiological Services have a copay of $20 to $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-042 (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, but the specific services of 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 are not covered. Prior authorization is required and there is a copay, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H0028-042 (HMO). The copay is $20 for days 1-20, and $214 for days 21-100, and there is no coinsurance. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services in the Humana Gold Plus H0028-042 (HMO) plan includes acupuncture with a $20 copay, up to 20 treatments per year, and a meal benefit with no copay, but 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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