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Humana Gold Plus H0028-053 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-053 (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 H0028-053 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-053 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Iowa and Nebraska. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-053 (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 H0028-053 (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 H0028-053 (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 $4200.00 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 H0028-053 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, there is no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generics are also highly affordable, with a $5 copay for a one-month supply at standard pharmacies, and no copay for a three-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at standard pharmacies and mail order options. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The Humana Gold Plus H0028-053 (HMO) plan offers comprehensive medical coverage with no deductibles and no copay for primary care visits, preventive services, and home health care. Specialist visits require a $40 copay, while inpatient hospital stays require a $395 daily copay for the first six days of acute stays. Outpatient hospital services feature copays ranging from no copay up to $300, and emergency room visits carry a $150 copay which is waived if you are admitted. Supplemental benefits include dental care with no copay or coinsurance for preventive and most comprehensive services up to a $2,500 annual limit. Routine vision and hearing exams are available with no copay, and prescription hearing aids require a copay of $699 to $999. Additionally, diagnostic lab work and outpatient X-rays feature no copay, while durable medical equipment requires a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H0028-053 (HMO) inpatient hospital services are partially covered with no coinsurance, requiring a $395 daily copay for days 1 to 6 of acute stays and a $380 daily copay for days 1 to 6 of psychiatric stays, with no copay for subsequent covered days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H0028-053 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a $0 to $300 copay, observation services have a $395 copay per stay, and outpatient substance abuse sessions require a $30 to $35 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Gold Plus H0028-053 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-053 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H0028-053 (HMO) covers emergency services with a $150 copay—waived if admitted to the hospital within 24 hours—and no coinsurance. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-053 (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Most other covered services, including physical, occupational, and mental health therapies, have copays ranging from $0 to $40 and no coinsurance, though podiatry is not covered and chiropractic services are only partially covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus H0028-053 (HMO) with no copay and no coinsurance for covered services, which include annual physical exams, kidney disease education, select screenings, and a memory fitness benefit. However, many additional services are not covered, such as health education, weight management programs, nutritional/dietary benefits, and in-home safety assessments.
Hearing Services See details
Humana Gold Plus H0028-053 (HMO) covers Medicare-covered hearing exams with a $40 copay and no coinsurance, while routine exams, fitting evaluations, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $699 to $999 for up to two devices per year, though inner ear, outer ear, and over the ear prescription hearing aids are not covered. There is no deductible for these hearing services, but prior authorization is required for exams.
Vision Services See details
Humana Gold Plus H0028-053 (HMO) provides partially covered vision services with no deductible and no coinsurance, featuring a $0 to $40 copay for eye exams and no copay for eyewear up to a $100 annual limit. Routine eye exams, contact lenses, and eyeglasses are covered, but other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-053 (HMO) partially covers dental services up to a $2,500 annual limit, offering preventive and most comprehensive care with no copay and no coinsurance, while prosthodontics require a 30% coinsurance and no copay. Medicare-covered dental has a $40 copay and no coinsurance, but fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-053 (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy may be required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus H0028-053 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H0028-053 (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with prior authorization required. DME, prosthetics, and medical supplies feature no copay and a 20% coinsurance, while diabetic supplies require no copay with a 10% to 20% coinsurance, and diabetic therapeutic shoes or inserts have a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-053 (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures range from a $0 to $95 copay, diagnostic radiology has a $0 minimum copay, and therapeutic radiology has a minimum copay of $40.
Home Health Services See details
Humana Gold Plus H0028-053 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-053 (HMO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered by the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H0028-053 (HMO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus H0028-053 (HMO), as acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits are covered, while other miscellaneous services are not. Acupuncture requires a $40 copay and no coinsurance, while OTC items and meal benefits are offered with no copay and no coinsurance.
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