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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 2025, 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, Nebraska, South Dakota. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-053 (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 $4.00. 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 $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 $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) plan has a $590 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance for your prescriptions. For Tier 1 (Preferred Generic) drugs, you'll pay a $10 copay at preferred pharmacies and mail order, and a $20 copay at standard pharmacies. For other tiers, you will pay a copay or coinsurance depending on the drug tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H0028-053 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0-$350. Emergency services and primary care visits have copays, while preventive services, such as annual physical exams, have no copay. This plan includes coverage for hearing, vision, and dental services, with some services having no copay and others having a copay or coinsurance. Other covered services include ambulance, home health, and skilled nursing facility (SNF) services. Additionally, the plan offers an over-the-counter (OTC) items benefit, meal benefit, and covers acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-6, and no copay for days 7-90, while additional days have no copay. For Inpatient Hospital Psychiatric, you will pay a $380 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a copay between $0 and $350, observation services with a $395 copay, and outpatient substance abuse services, with individual sessions costing between $40 and $95, and group sessions costing between $40 and $95. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0028-053 (HMO) plan, with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed and worldwide emergency services, are covered by the Humana Gold Plus H0028-053 (HMO) plan. Emergency Services have a $125 copay with no coinsurance, Urgently Needed Services have a $55 copay with no coinsurance, and Worldwide Emergency Services have a $125 copay with no coinsurance.
Primary Care See details
The Humana Gold Plus H0028-053 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, and physician specialist services with a $40 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions, physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a copay between $0-$55. The plan also covers Opioid Treatment Program Services with a copay between $40-$95.
Preventive Services See details
Preventive Services include an annual physical exam with no copay. Other preventive services, including 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
Hearing services include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered with a copay between $699 and $999, while OTC hearing aids are covered up to $50 every three months. Prescription hearing aids for the inner ear, outer ear, and over-the-ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered. There is a combined maximum of $100 per year for eyewear.
Dental Services See details
Dental Services are covered, with a yearly maximum of $1000. Medicare Dental Services have a $40 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services have no copay. Restorative Services and Prosthodontics, removable have a 30% coinsurance, and Prosthodontics, fixed have a 30% - 40% coinsurance, all with no copay. Fluoride Treatment, Maxillofacial Prosthetics, Orthodontics, and Implant Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Gold Plus H0028-053 (HMO), including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0-20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0-20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-053 (HMO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance, while Diabetic Supplies have a 10-20% coinsurance and no copay, and Medical Supplies and Prosthetic Devices have a 20% coinsurance and no copay. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Humana Gold Plus H0028-053 (HMO). Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $350, Therapeutic Radiological Services have a $40 copay, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-053 (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 covered, but there is no cost information provided. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H0028-053 (HMO) with prior authorization required. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $203.
Other Services See details
Under "Other Services", this Humana plan covers acupuncture with a $40 copay per visit, and a limit of 20 treatments per year. The plan also offers an over-the-counter (OTC) items benefit with a $50 maximum benefit every three months. This plan also covers a meal benefit with no copay. Other services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others are not covered.
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