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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 2026, 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 2026.
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 $14.00. 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 $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 $3200.00 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) medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and through preferred mail order for both 1-month and 3-month supplies. Tier 2 generic drugs cost $5 for a 1-month supply at standard pharmacies or via preferred mail order, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at standard pharmacies and preferred mail order, rising to $47 at standard mail order. Tier 4 non-preferred drugs require a 48% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance across standard pharmacy and mail order options. Understanding these tier costs helps beneficiaries budget their medication expenses when choosing between retail pharmacies and mail-order delivery.
Additional Benefits
The Humana Gold Plus H0028-059 (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $15 copay, while inpatient hospital stays carry a $225 daily copay for the first five days and no copay for days six through ninety. Emergency care is available with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. Supplemental benefits are also highly accessible, featuring no copays or coinsurance for routine dental care up to a $3,500 annual limit and select vision eyewear up to a $300 yearly limit. Members also receive up to 60 one-way transportation trips to approved health locations and routine hearing exams with no copay. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Humana Gold Plus H0028-059 (HMO) with no coinsurance and a copay of $225 per day for days 1 to 5, followed by no copay for days 6 to 90 for both acute and psychiatric stays. Unlimited additional acute days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H0028-059 (HMO) covers outpatient services with no coinsurance, although prior authorization is required for most services. Outpatient hospital and observation services carry a copay of $0 to $225, while outpatient substance abuse sessions have a copay of $20 to $35. Ambulatory surgical center and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H0028-059 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-059 (HMO) covers ambulance services with a $335 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Humana Gold Plus H0028-059 (HMO) 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 H0028-059 (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $15 copay and no coinsurance. Other covered benefits include physical and occupational therapy for a $25 copay, mental health and psychiatric sessions for a $20 copay, and telehealth services ranging from no copay to a $65 copay, all with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H0028-059 (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copays and no coinsurance. While a memory fitness benefit is covered with no copay and no coinsurance, several additional preventive services are not covered, including health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
Hearing services covered by Humana Gold Plus H0028-059 (HMO) require no deductible, featuring routine exams and fitting evaluations with no copay and no coinsurance, and Medicare-covered exams for a $15 copay and no coinsurance. Prescription hearing aids are partially covered with a $399 to $999 copay and no coinsurance, excluding inner ear, outer ear, and over the ear models. OTC hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H0028-059 (HMO) partially covers Vision Services, offering routine eye exams and select eyewear (such as contact lenses and eyeglasses) with no copay and no coinsurance, up to a $300 annual limit. Other eye exam services, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-059 (HMO) partially covers dental services up to a $3,500 annual maximum, offering Medicare-covered dental with a $15 copay and no coinsurance, and other covered preventive and comprehensive services with no copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-059 (HMO) covers Home Infusion bundled Services with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H0028-059 (HMO) with no copay and a 20% coinsurance, subject to prior authorization.
Medical Equipment See details
Humana Gold Plus H0028-059 (HMO) covers durable medical equipment (DME), 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.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-059 (HMO) covers diagnostic services with no coinsurance and copays ranging from $0 to $100, including no copay for lab services. Radiological services require prior authorization and feature no copay for outpatient X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance and $15 copay for therapeutic radiology.
Home Health Services See details
Humana Gold Plus H0028-059 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-059 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, subject to prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry copays ranging from $15.00 to $20.00.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-059 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H0028-059 (HMO) covers acupuncture with a $15 copay and no coinsurance, as well as over-the-counter items and meal benefits for chronic illnesses with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and other miscellaneous services are not covered.
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