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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 $2.00. 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 $4350.00 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 generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a 1-month supply at standard pharmacies, or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with savings available on 3-month preferred mail orders for a $131 copay. 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. These structured costs help you easily plan your prescription expenses under this Humana Medicare Advantage plan.
Additional Benefits
The Humana Gold Plus H0028-053 (HMO) plan offers comprehensive medical coverage with no copay for primary care physician visits and a $50 copay for specialists. For hospital care, inpatient acute stays require a $420 copay for days 1 through 6 and no copay for subsequent days, while emergency room visits carry a $130 copay. Outpatient hospital services feature a copay ranging from $0 to $300, and most medical services under this plan require no coinsurance. Beneficiaries also enjoy extra benefits, including routine dental, vision, and hearing exams with no copay. Home health services are fully covered with no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Additionally, the plan provides access to acupuncture with a $50 copay alongside over-the-counter items and chronic illness meal benefits at no copay.
Inpatient Hospital See details
Humana Gold Plus H0028-053 (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $420 copay for days 1 through 6 and no copay for day 7 and beyond. Inpatient psychiatric care is covered with no coinsurance and a $390 copay for days 1 through 6, with no copay for days 7 through 90, though upgrades, non-Medicare-covered stays, 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 copays for ambulatory surgical center and blood services. Outpatient hospital services carry a copay of $0 to $300, observation services require a $420 copay per stay, and outpatient substance abuse sessions have a copay of $30 to $35.
Partial Hospitalization See details
Humana Gold Plus H0028-053 (HMO) covers partial hospitalization services 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. Although transportation services are technically covered, they are not covered in practice as trips to plan-approved or any health-related locations are excluded.
Emergency Services See details
Humana Gold Plus H0028-053 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 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, and specialist visits with a $50 copay and no coinsurance. Other covered services like physical therapy, telehealth, and mental health sessions have copays ranging from $0 to $50 and no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Humana Gold Plus H0028-053 (HMO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training, with no copay and no coinsurance. While a memory fitness benefit is included, additional preventive services are only partially covered, with excluded services including health education, in-home safety assessments, personal emergency response systems, and nutritional counseling.
Hearing Services See details
Humana Gold Plus H0028-053 (HMO) hearing services cover Medicare-covered exams for a $50 copay and no coinsurance, while routine exams, fittings, and OTC hearing aids are available with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699 to $999 and no coinsurance, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Humana Gold Plus H0028-053 (HMO) provides partial coverage for vision services with no deductibles, featuring no coinsurance and copays ranging from no copay to $50 for covered eye exams, and no copay and no coinsurance for covered eyewear up to a $100 annual limit. Covered benefits include one routine eye exam and one pair of eyeglasses or contact lenses per year, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H0028-053 (HMO), with Medicare-covered dental requiring a $50 copay and no coinsurance, while other preventive and comprehensive services have no copay and no coinsurance. 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 is required. Medicare Part B drugs, including chemotherapy, radiation, insulin, and other drugs, are covered with coinsurance ranging from no coinsurance up to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Humana Gold Plus H0028-053 (HMO) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Humana Gold Plus H0028-053 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
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 and therapeutic radiological services require a minimum $50 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-053 (HMO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization, but in practice only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Humana Gold Plus H0028-053 (HMO) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Humana Gold Plus H0028-053 (HMO), offering acupuncture for a $50 copay and no coinsurance (up to 20 treatments per year), alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while other miscellaneous services (Other 1, 2, 3) and Dual Eligible SNPs are not covered.
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