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Humana Gold Plus SNP-DE H0028-045 (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 H0028-045 (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 H0028-045 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Cameron, Hidalgo and Willacy counties. 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 H0028-045 (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 H0028-045 (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 H0028-045 (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 H0028-045 (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 $230.00 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 H0028-045 (HMO D-SNP) plan has a $230 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, there is no copay at preferred pharmacies or through the mail, but a $20 copay at standard mail pharmacies. For other tiers, you may pay 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services with varying copays and coinsurance. You'll also find coverage for emergency services, primary care, preventive services, hearing, vision, and dental. Many services, such as home health and preventive care, have no copay, while others involve coinsurance, such as outpatient services and specialist visits. This plan also includes additional benefits like transportation services, with 48 one-way trips per year to health-related locations, and over-the-counter items with a $1200 annual limit. While some services like skilled nursing and ambulance services are covered, they may require prior authorization or involve copays and coinsurance.
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. Inpatient Hospital-Acute has a copay of $2,185 per stay, and Additional Days for Inpatient Hospital-Acute has no copay. Inpatient Hospital Psychiatric has a copay of $2,036 per stay; however, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance, and Outpatient Substance Abuse Services with a 20% coinsurance. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, 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, and transportation services with no copay. Transportation services to any health-related location are not covered. Transportation services to plan-approved health-related locations are covered for 48 one-way trips per year, via taxi, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under this plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services have a 20% coinsurance.
Primary Care See details
Primary Care, including Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services and Physician Specialist Services have a 20% coinsurance. Occupational Therapy Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Physical Therapy and Speech-Language Pathology Services and Additional Telehealth Benefits have a 20% coinsurance with no copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and kidney disease education services with no copay. Some additional preventive services like Health Education, In-Home Safety Assessment, and others are not covered. Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP) covers hearing exams with a coinsurance of at most 20% and a copay for Medicare-covered benefits, and fitting/evaluation for hearing aids with no copay. The plan also covers prescription hearing aids, with a maximum benefit of $1,000 every three years, and OTC hearing aids with no copay and a maximum benefit of $1,000 every three years; however, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, other dental services with a $2,500 maximum benefit per year, Oral Exams with no copay for up to 3 visits per year, Dental X-Rays with no copay for up to 3 visits, Other Diagnostic Dental Services with no copay for up to 1 visit every three years, Prophylaxis (Cleaning) with no copay for up to 2 visits per year, Restorative Services with no copay for up to 3 visits, Adjunctive General Services with no copay for up to 3 visits, Endodontics with no copay for up to 2 visits, Periodontics with no copay for up to 2 visits every three years, Prosthodontics, fixed with no copay for up to 4 visits, and Oral and Maxillofacial Surgery with no copay for up to 2 visits; 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance and no copay. Prior authorization is required for coverage.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, with Lab Services also having no copay. Diagnostic, Therapeutic, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered 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 not covered by Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP). This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, 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
Other Services include acupuncture with 20% coinsurance, over-the-counter items with a $1200 annual limit, and a meal benefit with no copay; 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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