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Humana Gold Plus H0028-046 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-046 (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 H0028-046 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-046 (HMO) is a HMO 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 2026.
It's important to know that Humana Gold Plus H0028-046 (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 H0028-046 (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 H0028-046 (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 $1.00. 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 $3400.00 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 H0028-046 (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for 1-month and 3-month supplies at standard retail pharmacies or through preferred mail order. Standard mail order for these tiers requires a copay of $10 to $20 for a 1-month supply. Tier 3 preferred brand drugs have a $45 copay for a 1-month supply at standard pharmacies and preferred mail order, which increases to $47 at standard mail order. Tier 4 non-preferred drugs require a 48% coinsurance for both 1-month and 3-month supplies across all pharmacy types. Tier 5 specialty medications carry a 25% coinsurance for a 1-month supply at standard pharmacies, preferred mail order, and standard mail order.
Additional Benefits
The Humana Gold Plus H0028-046 (HMO) plan offers affordable healthcare coverage featuring no copay for primary care visits, preventive services, and home health care. Specialist visits require a low $15 copay, while inpatient hospital stays carry a $295 copay per admission with no coinsurance. Outpatient services are also highly accessible, with costs ranging from no copay up to a $225 copay depending on the service. This plan provides robust supplemental benefits, including routine vision exams, comprehensive dental care up to a $3,000 annual limit, and routine hearing services with no copay. Members also benefit from up to 60 one-way transportation trips per year to plan-approved locations with no copay. Essential durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H0028-046 (HMO) covers inpatient acute and psychiatric hospital stays with a $295 copayment per admission and no coinsurance. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H0028-046 (HMO) with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services require a copay of $0 to $225, observation services have a $295 copay per stay, and outpatient substance abuse sessions carry a $20 to $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H0028-046 (HMO) with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-046 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, but transportation to any health-related locations is not covered.
Emergency Services See details
Emergency services under the Humana Gold Plus H0028-046 (HMO) plan are covered with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with 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 H0028-046 (HMO) offers primary care physician visits with no copay and no coinsurance, specialist visits for a $15 copay and no coinsurance, and physical, occupational, and speech therapies for a $20 copay and no coinsurance. Mental health and psychiatric services require a $20 copay and no coinsurance, podiatry is not covered, and while some chiropractic services are covered with a $15 copay and no coinsurance, routine and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H0028-046 (HMO) covers preventive services, annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. Additional preventive benefits are partially covered, offering a memory fitness benefit with no copay and no coinsurance, while excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary services, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Humana Gold Plus H0028-046 (HMO) covers hearing services with no deductible, offering Medicare-covered exams for a $15 copay and no coinsurance, while routine exams, fittings, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $299 for up to two devices every three years, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H0028-046 (HMO), offering one routine eye exam and one pair of eyeglasses (lenses and frames) or contact lenses per year with no copay, no coinsurance, and no deductible, up to a $400 annual maximum. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-046 (HMO) provides partially covered dental services with an annual maximum of $3,000, featuring no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require a $15 copay and no coinsurance, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-046 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Part B insulin carries a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H0028-046 (HMO) with no copay and a 20% coinsurance. This benefit requires both a referral and prior authorization.
Medical Equipment See details
Humana Gold Plus H0028-046 (HMO) covers durable medical equipment, prosthetics, and medical supplies with 20% coinsurance and no copay. Diabetic supplies are covered with 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and 10% to 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-046 (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and copays ranging from $0 to $65 for diagnostic tests. Covered radiological services require no copay for outpatient X-rays and diagnostic radiology, while therapeutic radiological services require a minimum 20% coinsurance and copays starting at $15.
Home Health Services See details
Humana Gold Plus H0028-046 (HMO) covers Home Health Services with no copay and no coinsurance, although a referral and prior authorization are required to receive care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H0028-046 (HMO) with no coinsurance, although some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. These non-covered services require a copayment of $15 or $20, and prior authorization and referrals are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H0028-046 (HMO) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Humana Gold Plus H0028-046 (HMO) partially covers other services with no copay and no coinsurance, including up to 12 acupuncture treatments per year, over-the-counter items via reimbursement, and meal benefits for chronic illnesses. Prior authorization is required for acupuncture and meals, and some CMS over-the-counter list drugs as well as other miscellaneous services are not covered.
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