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Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Austin 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 SNP-DE H0028-044 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP).
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 SNP-DE H0028-044 (HMO D-SNP), 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $590.00 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 $9350.00 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 SNP-DE H0028-044 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For preferred generic drugs, you will pay no copay at a standard pharmacy or a preferred mail pharmacy, and a $20 copay at a standard mail pharmacy. For standard generic drugs, you will pay a $47 copay at a standard, preferred mail, and standard mail pharmacy. Preferred brand and non-preferred drugs have a 25% coinsurance.
Additional Benefits
The Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) plan offers a range of benefits with varying costs. Hospital stays have a copay, while outpatient services typically involve 20% coinsurance. Emergency services have a copay, and ambulance services have a 20% coinsurance. Preventive, hearing, and vision services often have no copay, with some services like prescription hearing aids and eyewear having set maximum coverage amounts. Dental services have no copay for many services, while other services such as home health, and skilled nursing facilities have no copay for specific days, or have coinsurance requirements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor's referral. For Inpatient Hospital-Acute, you will pay a copay of $2185 per admission or stay, and for Inpatient Hospital Psychiatric, the copay is $2036 per admission or stay; Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a 20% coinsurance, and ASC services and outpatient substance abuse services have a coinsurance of 20%. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered under this plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground and air ambulance services with a 20% coinsurance, as well as transportation services with no copay. 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 SNP-DE H0028-044 (HMO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, Chiropractic Services, Occupational Therapy Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered, with coinsurance of 20% for most services. Routine Chiropractic Care and Podiatry Services are not covered. Additional Telehealth Benefits have no copay.
Preventive Services See details
The Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additionally, the plan covers glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit with no copay. However, other services such as health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% for routine hearing exams, and no copay. Prescription hearing aids are covered, with a maximum plan benefit coverage of $1,000 every three years, and no copay. OTC hearing aids are covered with a $0 copay, and a maximum plan benefit coverage of $1,000 every three years.
Vision Services See details
The Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) plan covers vision services including eye exams and eyewear. Eye exams have no copay and a 20% coinsurance, while routine eye exams have no copay. Eyewear has a combined maximum plan benefit coverage of $250 per year, with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Under the Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) plan, Medicare Dental Services are covered with a 20% coinsurance after prior authorization and a doctor referral. Other Dental Services include Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, and Prosthodontics, fixed, and Oral and Maxillofacial Surgery, all of which have no copay; however, Fluoride Treatment, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay with a coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20% with no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment includes Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and no copay. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies has a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts has no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services has a $0 copay and a coinsurance of at most 20%. Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a 20% coinsurance and requires prior authorization, while OTC items have a maximum plan benefit coverage amount of $1200 per year. The meal benefit has no copay and requires prior authorization. Services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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