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Humana Gold Plus H0028-043 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-043 (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 H0028-043 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-043 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Northeast 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 H0028-043 (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 H0028-043 (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 H0028-043 (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 $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 $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 H0028-043 (HMO) plan has a $200 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $5 copay at a standard pharmacy for preferred generic drugs. For preferred brand drugs, you will pay 38% coinsurance, regardless of the pharmacy used. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus H0028-043 (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and ambulance services. It also covers emergency services, primary care, and preventive services with varying copays, as well as hearing, vision, and dental services with no or low copays and a $2,500 annual maximum for dental. Additional benefits include home health services with no copay, and coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities with copays or coinsurance. The plan also covers acupuncture, OTC items, and a meal benefit, but excludes certain services like private duty nursing and home and community-based services.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a $260 copay for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital-acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades for inpatient hospital-acute, and 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 $200, observation services with a $260 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $20 and $100 for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H0028-043 (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services and transportation services to plan-approved health-related locations. Ground ambulance services have a $315 copay, and air ambulance services have 20% coinsurance. Transportation services to plan-approved health-related locations have no copay, up to 24 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 under the Humana Gold Plus H0028-043 (HMO) plan. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $65 copay and no coinsurance, and Worldwide Emergency Services have a $140 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Gold Plus H0028-043 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $20 copay, and physical therapy and speech-language pathology services with a $25 copay. Mental health and psychiatric services have a $20 copay for individual and group sessions, and additional telehealth benefits have a copay ranging from $0 to $65. Opioid treatment program services have a copay ranging from $20 to $100. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services including fitness benefits, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit with no copay. 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.
Hearing Services See details
The Humana Gold Plus H0028-043 (HMO) plan covers hearing exams with a $20 copay, routine hearing exams once per year with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but not for inner ear, outer ear, or over the ear aids, and have a copay between $499 and $799 for all other types. OTC hearing aids are covered with a maximum benefit of $40 every three months.
Vision Services See details
The Humana Gold Plus H0028-043 (HMO) plan covers vision services, including eye exams with a copay between $0 and $20, and eyewear with no copay, up to a combined maximum of $150 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H0028-043 (HMO) plan covers dental services with a $2,500 annual maximum. Medicare dental services have a $20 copay, while oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral/maxillofacial surgery have no copay. However, fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H0028-043 (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-043 (HMO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a 20% coinsurance, Diabetic Supplies with a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $100, and Lab Services with no copay. Radiological Services include Diagnostic Radiological Services with a copay up to $325, Therapeutic Radiological Services with a copay up to $20 and 20% coinsurance, and Outpatient X-Ray Services with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-043 (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 plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H0028-043 (HMO) plan with prior authorization required. For days 1-20, the copay is $20, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H0028-043 (HMO) plan covers acupuncture with a $20 copay, and covers Over-the-Counter (OTC) items, with a maximum plan benefit coverage amount of $40 every three months. The plan also covers a meal benefit with no copay. However, the plan does not cover 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, or Self-Directed Personal Assistance Services.
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