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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 $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 H0028-054 (HMO-POS) prescription drug plan features an annual drug deductible of $400. You can save on coverage with no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through preferred mail order. Tier 2 generic drugs cost as little as a $5 copay for a 1-month supply, and you pay no copay for a 3-month supply when choosing preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $47 copay for a 1-month supply. Tier 4 non-preferred drugs require a 48% coinsurance, while Tier 5 specialty medications carry a 28% coinsurance for a 1-month supply across all pharmacy and mail order options.
Additional Benefits
The Humana Gold Plus H0028-054 (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. Specialist visits require a $30 copay, while inpatient hospital stays incur a $320 daily copay for the first five days and no copay for days six through ninety. Emergency room visits carry a $150 copay, and urgent care is available for a $65 copay, with no coinsurance required for either service. For supplemental benefits, members enjoy no copay on routine hearing exams, routine vision exams, and preventive dental services up to a $1,000 annual limit. Diagnostic lab services and outpatient X-rays are also covered with no copay. However, specialized medical needs like durable medical equipment and dialysis services require a 20% coinsurance, while ground ambulance services carry a $335 copay.
Inpatient Hospital See details
Humana Gold Plus H0028-054 (HMO-POS) inpatient hospital benefits feature no coinsurance and require a $320 daily copay for days 1 through 5, with no copay for days 6 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H0028-054 (HMO-POS) covers outpatient services with no coinsurance, although prior authorization is required. Outpatient hospital services require a copay of $0 to $300 ($320 per stay for observation), outpatient substance abuse sessions have a $30 to $35 copay, while ambulatory surgical center and blood services have no copay.
Partial Hospitalization See details
Humana Gold Plus H0028-054 (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-054 (HMO-POS) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services to plan-approved or any 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 and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-054 (HMO-POS) features primary care physician services with no copay and no coinsurance, while specialist and psychiatric services require a $30 copay and no coinsurance. Physical and occupational therapy services carry a $25 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H0028-054 (HMO-POS) covers preventive services, including annual physical exams, kidney education, and a memory fitness benefit, with no copay and no coinsurance. However, these additional benefits are only partially covered, as sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, and in-home support are not covered.
Hearing Services See details
Humana Gold Plus H0028-054 (HMO-POS) partially covers hearing services, offering routine hearing exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Medicare-covered exams require a $30 copay with no coinsurance, and while up to two annual prescription hearing aids are covered with a $699 to $999 copay and no coinsurance, inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Humana Gold Plus H0028-054 (HMO-POS) offers partially covered vision services with no deductible, no coinsurance, and a copay of $0 to $30 for eye exams, which includes one routine exam per year with no copay. Covered eyewear has no copay up to a $100 annual limit for one pair of contact lenses or eyeglasses (lenses and frames) per year, though other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-054 (HMO-POS) offers partially covered dental services up to a $1,000 annual limit, featuring no copay and no coinsurance for preventive care, fillings, root canals, and extractions, while Medicare-covered dental has a $30 copay (no coinsurance) and prosthodontics require a 30% coinsurance (no copay). Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-054 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other Part B drugs are covered with no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% 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 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 no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H0028-054 (HMO-POS) with no coinsurance, though prior authorization is required. Members pay no copay for lab services, outpatient X-rays, and diagnostic radiological services, while diagnostic procedures range from a $0 to $100 copay and therapeutic radiological services start at a $30 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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H0028-054 (HMO-POS) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H0028-054 (HMO-POS) with no coinsurance, featuring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, but a prior three-day inpatient hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus H0028-054 (HMO-POS) provides partial coverage for other services, offering acupuncture for a $30.00 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Sub-services including Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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