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Humana Gold Plus H0028-059 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-059 (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 H0028-059 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-059 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Dallas area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-059 (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 H0028-059 (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 H0028-059 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $6.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $200.00 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 $3450.00 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 H0028-059 (HMO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy type. For example, in the initial coverage phase, you may pay a $9 copay for a preferred generic drug at a standard pharmacy, or 34% coinsurance for a preferred brand drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H0028-059 (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays. You'll have no copay for many services, such as primary care visits, preventive services like annual physical exams, outpatient blood services, and routine hearing exams, while other services like emergency services and hearing exams have copays. The plan also covers ambulance services, with a copay for ground ambulance and coinsurance for air ambulance. Additionally, the plan includes vision and dental coverage, offering eye exams and eyewear with no copay, and dental services with a copay or coinsurance depending on the service. The plan also covers home health services, dialysis services, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by Humana Gold Plus H0028-059 (HMO), with a copay of $225 per day for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $225, Observation Services with a $225 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $20 and $100 for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H0028-059 (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations have no copay, and are limited to 60 one-way trips per year. 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 under the Humana Gold Plus H0028-059 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $65 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus H0028-059 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $20 copay, mental health and psychiatric services with a $20 copay, physical therapy and speech-language pathology services with a $25 copay, additional telehealth services with a copay from $0 to $65, and opioid treatment program services with a $20-$100 copay. The plan does not cover routine chiropractic care or podiatry services.
Preventive Services See details
Preventive Services are covered by Humana Gold Plus H0028-059 (HMO), including annual physical exams with no copay, and additional preventive services with a copay that depends on the service. Other services, such as health education, in-home safety assessments, and various therapies, are not covered.
Hearing Services See details
The Humana Gold Plus H0028-059 (HMO) plan covers hearing exams with a $20 copay, and routine hearing exams with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $999, while prescription hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H0028-059 (HMO) plan covers vision services, including eye exams with a copay between $0 and $20, and eyewear with no copay, up to a combined maximum of $300 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay and Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services with a 30-40% coinsurance and Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable with a 30% coinsurance, and Oral and Maxillofacial Surgery with no copay. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
The Humana Gold Plus H0028-059 (HMO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires authorization. Prosthetic Devices and Medical Supplies are covered with a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Humana Gold Plus H0028-059 (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $100, lab services with no copay, diagnostic radiological services with a copay up to $325, therapeutic radiological services with a copay up to $15 and 20% coinsurance, and outpatient X-ray services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-059 (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 not covered by the Humana Gold Plus H0028-059 (HMO) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit if it were covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H0028-059 (HMO), with a copay of $20 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $20 copay, but is limited to 20 treatments per year, and a meal benefit with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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