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Humana Gold Plus H0028-054 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-054 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H0028-054 (HMO-POS) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-054 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Kansas City. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-054 (HMO-POS) 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 H0028-054 (HMO-POS).
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 H0028-054 (HMO-POS), 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 $400.00 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 $2800.00 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 H0028-054 (HMO-POS) Medicare Advantage plan features an annual prescription drug deductible of $400. For Tier 1 preferred generic drugs, members enjoy no copay when using standard pharmacies or preferred mail order services. Tier 2 generic medications are also highly affordable, costing as little as a $5 copay for a one-month supply, or no copay for a three-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply across standard pharmacies and mail-order options. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring a 48% coinsurance and Tier 5 specialty drugs carrying a 28% coinsurance. Choosing preferred mail order and standard pharmacies helps maximize your savings under this plan.
Additional Benefits
The Humana Gold Plus H0028-054 (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care, preventive care, and home health services. Specialist visits require a $15 copay, while inpatient hospital stays require a copay of $395 per day for the first seven days of an acute stay. Emergency care is covered with a $150 copay, and urgent care is available for a $65 copay, with no coinsurance required for either service. For routine care, the plan provides dental, vision, and hearing services with no copay, though limits and up to a 30% coinsurance can apply depending on the specific service. Durable medical equipment and dialysis require a 20% coinsurance with no copay, while laboratory tests and outpatient X-rays are covered with no copay and no coinsurance. Members also have access to acupuncture for a $15 copay, as well as over-the-counter items and meal programs with no copay.
Inpatient Hospital See details
Humana Gold Plus H0028-054 (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a copay of $395 per day for days 1-7 of an acute stay and $334 per day for days 1-7 of a psychiatric stay, with no copay for additional days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
Humana Gold Plus H0028-054 (HMO-POS) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $300 copay, observation services cost a $395 copay per stay, and outpatient substance abuse sessions have a $30 to $35 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Gold Plus H0028-054 (HMO-POS) with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-054 (HMO-POS) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H0028-054 (HMO-POS) covers emergency services with a $150 copay (waived if admitted within 24 hours) and urgently needed services with a $65 copay, with no coinsurance required for either service. Worldwide emergency, urgent care, and emergency transportation are also covered under the plan with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-054 (HMO-POS) covers primary care with no copay and no coinsurance, and specialist visits for a $15 copay and no coinsurance. Other services like telehealth, therapy, and psychiatric care feature copays ranging from $0 to $65 and no coinsurance, though podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Humana Gold Plus H0028-054 (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and a memory fitness benefit, with no copay and no coinsurance. These services are only partially covered, as the plan does not cover health education, in-home safety assessments, personal emergency response systems, or nutritional and dietary benefits.
Hearing Services See details
Humana Gold Plus H0028-054 (HMO-POS) offers partially covered hearing services, excluding inner ear, outer ear, and over the ear prescription hearing aids. Medicare-covered exams have a $15 copay, while routine exams, fitting evaluations, and OTC hearing aids have no copay, all with no coinsurance. Covered prescription hearing aids are limited to two per year and require a copay between $699 and $999 with no coinsurance.
Vision Services See details
Humana Gold Plus H0028-054 (HMO-POS) provides partially covered vision services, featuring one routine eye exam and eyewear like contact lenses or eyeglasses (lenses and frames) per year with no copay and no coinsurance up to a $100 limit. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-054 (HMO-POS) partially covers dental services, offering Medicare-covered dental for a $15 copay and no coinsurance, and other covered services for no copay and either no coinsurance or 30% coinsurance up to a $1,000 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus H0028-054 (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0028-054 (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H0028-054 (HMO-POS) 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 and inserts require a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-054 (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. There is no copay for lab and outpatient X-ray services, while diagnostic procedures and tests have a copay of up to $65, and therapeutic radiological services require a minimum copay of $15.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H0028-054 (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided with no coinsurance under the Humana Gold Plus H0028-054 (HMO-POS) plan, though only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-054 (HMO-POS) covers skilled nursing facility (SNF) services 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, and additional days beyond the 100-day limit are not covered.
Other Services See details
Humana Gold Plus H0028-054 (HMO-POS) offers partially covered other services, including acupuncture for a $15.00 copay and no coinsurance, alongside over-the-counter items and chronic illness meals with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and some other miscellaneous services are not covered.
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