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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 2026, 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 Select Counties in 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 H0028-043 (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 $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 $3200.00 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 features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic prescriptions are also highly affordable, costing as little as a $5 copay for a 1-month supply, or no copay for a 3-month supply when using preferred mail order. For Tier 3 preferred brand drugs, copays start at $45 for a 1-month supply at standard pharmacies and preferred mail order. Tier 4 non-preferred drugs require a 48% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance across standard pharmacies and mail order options. This structured coverage helps you manage prescription costs effectively based on your specific medication tier and pharmacy choice.
Additional Benefits
The Humana Gold Plus H0028-043 (HMO) plan offers affordable healthcare coverage with no copay for primary care visits and a low $15 copay for specialist appointments. For hospital care, inpatient stays require a $225 daily copay for the first five days and no copay for days 6 through 90, while home health services feature no copay. Outpatient surgical services and lab tests are also covered with no copay, making essential medical care highly accessible. In addition to medical care, this plan provides generous supplemental benefits including dental coverage up to a $2,500 annual limit and routine vision care with a $150 eyewear allowance, both with no copay. Members also enjoy no copay for routine hearing exams, over-the-counter items, and up to 24 routine one-way transportation trips per year. These comprehensive benefits help minimize out-of-pocket costs for everyday health and wellness needs.
Inpatient Hospital See details
Humana Gold Plus H0028-043 (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization and a $225 daily copay for days 1 through 5, followed by no copay for days 6 through 90. While unlimited additional acute care days are covered at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H0028-043 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Prior authorization is required for these services, which feature a $0 to $200 copay for outpatient hospital visits, a $225 copay per stay for observation services, and a $20 to $35 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus H0028-043 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-043 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Routine transportation is partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H0028-043 (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services carry a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-043 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Physical, occupational, and speech therapy require a $25 copay and no coinsurance, while mental health and psychiatric sessions have a $20 copay and no coinsurance. Chiropractic services are partially covered, excluding routine and other chiropractic services, while podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Humana Gold Plus H0028-043 (HMO) with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and a memory fitness benefit. However, several supplemental services are not covered, including health education, in-home safety assessments, weight management programs, and nutritional/dietary benefits.
Hearing Services See details
Humana Gold Plus H0028-043 (HMO) covers hearing services with no deductible, offering Medicare-covered exams for a $15 copay and no coinsurance, alongside routine exams, fittings, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $499 to $799 and no coinsurance, but inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Gold Plus H0028-043 (HMO) partially covers vision services with no deductible, no coinsurance, and no copay for covered services, though prior authorization is required. Covered benefits include one routine eye exam and a $150 annual allowance for select eyewear, while other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H0028-043 (HMO), featuring a $15.00 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered dental benefits up to a $2,500 annual limit. While many preventive and comprehensive services are covered, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H0028-043 (HMO) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and a coinsurance of no coinsurance to 20%. Covered Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus H0028-043 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Humana Gold Plus H0028-043 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H0028-043 (HMO) with prior authorization required. Outpatient lab services, x-rays, and diagnostic radiology feature no copay, diagnostic tests range from no copay to a $100 copay with no coinsurance, and therapeutic radiology requires a minimum 20% coinsurance and a $15 copay.
Home Health Services See details
Home health services are covered by Humana Gold Plus H0028-043 (HMO) with no copay and no coinsurance. Prior authorization is required before you can receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H0028-043 (HMO) with no coinsurance and a $20 copay, though prior authorization is required. Some services are covered, but Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-043 (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H0028-043 (HMO) covers other services including acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance. Acupuncture is limited to 25 treatments per year, and both acupuncture and meal benefits require prior authorization.
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