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Humana Gold Plus H0028-047 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-047 (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 H0028-047 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-047 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Colorado. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-047 (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 H0028-047 (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 H0028-047 (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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5300.00 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 H0028-047 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay a $12 copay at a standard pharmacy for a preferred generic drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0 for your prescriptions. Please check the plan's formulary for specific drugs covered.
Additional Benefits
The Humana Gold Plus H0028-047 (HMO) plan offers a range of benefits with varying cost-sharing. It covers inpatient hospital stays with a copay for the first few days, and outpatient services like primary care with copays. The plan includes coverage for emergency services, hearing, vision, and dental services. It also offers additional benefits such as home health services, and some over-the-counter items, with copays or coinsurance applying to specific services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under this plan. For Inpatient Hospital-Acute, you will pay a $330 copay for days 1-5, and no copay for days 6-90, while additional days (91-999) have no copay; for Inpatient Hospital Psychiatric, you will pay a $330 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $250, Observation Services have a $330 copay, Ambulatory Surgical Center Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a $20 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0028-047 (HMO) plan, with a $20 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0028-047 (HMO) plan. Ground ambulance services have a $315 copay, and air ambulance services have a $1250 copay, while 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 H0028-047 (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The Humana Gold Plus H0028-047 (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, and Occupational Therapy Services with a $30 copay. It also covers Physician Specialist Services with a $45 copay, Mental Health Specialty Services with a $20 copay, Podiatry Services with a $45 copay, and Physical Therapy and Speech-Language Pathology Services with a $30 copay. The plan also covers additional telehealth benefits with a copay between $0 and $55, and Opioid Treatment Program Services with a $20 copay.
Preventive Services See details
Preventive Services include no copay for Medicare-covered services, annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, and fitness benefits. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The Humana Gold Plus H0028-047 (HMO) plan covers hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. This plan also covers prescription hearing aids, but only covers prescription hearing aids (all types), with a copay between $699 and $999, and OTC hearing aids with a maximum benefit of $50 every three months.
Vision Services See details
Humana Gold Plus H0028-047 (HMO) covers vision services, including routine eye exams with a copay of $0-$45, and eyewear with a copay of $0 and a combined maximum of $150 per year. Contact lenses and eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-047 (HMO) covers dental services, with a $45 copay for Medicare dental services, and covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. This plan does not cover fluoride treatment, maxillofacial prosthetics, implant services, or orthodontics. Prosthodontics (removable and fixed) have a 30% coinsurance, and oral and maxillofacial surgery has no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H0028-047 (HMO) plan. For Medicare Part B Insulin Drugs, there is 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 H0028-047 (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a coinsurance between 10% and 20% depending on the service. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $55, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $330, and Therapeutic Radiological Services have a copay up to $45 and a coinsurance up to 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-047 (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 not covered by the Humana Gold Plus H0028-047 (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services require prior authorization, and the plan covers days 1-20 with a $10 copay per day, and days 21-100 with a $214 copay per day. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H0028-047 (HMO) plan covers acupuncture with a $45 copay, up to 20 treatments per year, and requires prior authorization. Over-the-counter (OTC) items are covered, with a maximum benefit of $50 every three months, and the plan also offers a meal benefit with no copay. Other 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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