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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 2025, 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 Select Counties in Kansas and Missouri. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-054 (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 $250.00 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 $3000.00 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) plan has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, for preferred generic drugs at a standard pharmacy, you will pay a $5 copay. For preferred brand drugs, you will pay 45% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus H0028-054 (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $295 copay for the first seven days, with no copay for the rest of the stay. Outpatient services have a copay ranging from $0 to $300, and emergency services have a $140 copay. The plan also includes coverage for primary care visits with no copay, and specialist visits with a $15 copay. Hearing, vision, and dental services are covered, with specific copays and coverage limits for each. The plan also provides coverage for ambulance services, home health, and skilled nursing facilities with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $295 copay for days 1-7, and no copay for days 8-90, while Additional Days are covered with no copay. For Inpatient Hospital Psychiatric, you pay a $295 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $300, Observation Services with a $295 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $35 and $40 for individual or group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0028-054 (HMO-POS) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0028-054 (HMO-POS) plan. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. 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 by the Humana Gold Plus H0028-054 (HMO-POS) plan. Emergency Services have a $140 copay and no coinsurance, while Urgently Needed Services have a $65 copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $140 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus H0028-054 (HMO-POS) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $15 copay, Physician Specialist Services with a $15 copay, Mental Health Specialty Services with a $15 copay, Other Health Care Professional with a copay between $0 and $15, Psychiatric Services with a $15 copay, Physical Therapy and Speech-Language Pathology Services with a $15 copay, Additional Telehealth Benefits with a copay between $0 and $65, and Opioid Treatment Program Services with a copay between $35 and $40. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and other services such as Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. Additional preventive services and Kidney Disease Education Services are covered, with a copay that is not specified.
Hearing Services See details
Hearing Services include hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) having a copay between $699 and $999, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are covered up to $50 every three months.
Vision Services See details
Vision services include eye exams and eyewear. Routine eye exams have no copay, and eyewear has a $0 copay, with a combined maximum benefit of $100 per year.
Dental Services See details
Dental Services are covered, with a $15 copay for Medicare Dental Services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs also have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0028-054 (HMO-POS) plan, and require prior authorization. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 14% coinsurance and Prosthetic Devices and Medical Supplies with 20% coinsurance, while Diabetic Supplies have a coinsurance between 10% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered, and Diabetic Supplies and Services are limited to specific manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $65, and Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $350, Therapeutic Radiological Services have a copay between $20 and $30, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-054 (HMO-POS) 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 not in practice since Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H0028-054 (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $203; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H0028-054 (HMO-POS) plan covers acupuncture with a $15 copay, up to 20 treatments per year. Over-the-counter (OTC) items are covered, including nicotine replacement therapy and naloxone, with a maximum benefit of $50 every three months. The plan also covers 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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