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Humana Gold Plus H0028-062 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-062 (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 H0028-062 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-062 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Yavapai. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-062 (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 H0028-062 (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 H0028-062 (HMO), 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 $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 $4900.00 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 H0028-062 (HMO) plan features an enhanced alternative drug benefit with a 615 dollar annual prescription drug deductible. After meeting this deductible, you enter the initial coverage phase where Tier 1 preferred generic drugs have no copay at standard pharmacies and through preferred mail order. For other tiers during this phase, standard generics require a 47 dollar copay, while you will pay 50 percent coinsurance for preferred brands and 25 percent coinsurance for non-preferred drugs. These initial coverage rates apply until your yearly out-of-pocket drug costs reach 2,100 dollars, at which point you enter the catastrophic coverage phase. Once in this phase, you will pay nothing for covered Medicare Part D prescription drugs. Furthermore, individuals who qualify for the low-income subsidy can receive a premium reduction, lowering their Part D cost to zero dollars.
Additional Benefits
The Humana Gold Plus H0028-062 (HMO) plan offers comprehensive medical coverage featuring no copay for primary care visits, routine preventive services, and home health care. For inpatient hospital stays, members pay a $350 daily copay for days 1 through 6, with no copay for days 7 and beyond. Emergency care is accessible with a $130 copay, which is waived upon admission, while outpatient ambulatory surgical services require no copay. Supplemental care is highly affordable, with no copay for routine eye exams, routine hearing exams, and most preventive dental services up to a $2,000 annual limit. Vision benefits include up to a $350 annual eyewear allowance with no copay, and prescription hearing aids carry a copay between $499 and $799. Skilled nursing facility care is also covered, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Humana Gold Plus H0028-062 (HMO) partially covers inpatient hospital services, requiring prior authorization and a $350 daily copay for days 1 to 6, with no copay for days 7 and beyond and no coinsurance. Upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H0028-062 (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Other covered services require copays, including $25 to $35 for outpatient substance abuse sessions, $0 to $350 for outpatient hospital services, and $350 per stay for observation services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Gold Plus H0028-062 (HMO) with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-062 (HMO) partially covers Ambulance and Transportation Services, as plan-approved and any health-related transportation services are not covered. Covered ground ambulance services require a $335 copay and air ambulance services require a $630 copay, both with no coinsurance.
Emergency Services See details
Humana Gold Plus H0028-062 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-062 (HMO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services require copays ranging from $0 to $50 with no coinsurance. Chiropractic services are partially covered, as routine chiropractic care is not covered by the plan.
Preventive Services See details
Humana Gold Plus H0028-062 (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive services are partially covered, meaning memory fitness and chemotherapy wigs are covered, while sub-services like health education, weight management, and in-home support are not covered.
Hearing Services See details
Humana Gold Plus H0028-062 (HMO) covers hearing services with no coinsurance or deductible, offering routine exams, fitting evaluations, and over-the-counter hearing aids with no copay, and Medicare-covered exams for a $30 copay. Prescription hearing aids are partially covered with a $499 to $799 copay for up to two aids per year, though inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Vision Services are partially covered by Humana Gold Plus H0028-062 (HMO), offering eye exams with a $0 to $30 copay (no copay for routine exams) and covered eyewear with no copay up to a $350 annual limit, with no coinsurance or deductibles. Prior authorization is required, and eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H0028-062 (HMO) up to a $2,000 yearly limit, excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental has a $30 copay and no coinsurance, while most preventive and comprehensive services require no copay and no coinsurance, except for prosthodontics which have a 30% coinsurance and no copay.
Home Infusion bundled Services See details
Humana Gold Plus H0028-062 (HMO) covers home infusion bundled services with prior authorization, requiring a $35 copay and no coinsurance to 20% coinsurance for Medicare Part B insulin drugs. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H0028-062 (HMO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Humana Gold Plus H0028-062 (HMO) covers medical equipment, including durable medical equipment (DME) with a 15% coinsurance and no copay. Diabetic supplies carry a 10% to 20% coinsurance and no copay, diabetic shoes require a $10 copay, and prosthetic devices carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H0028-062 (HMO) with no copay for lab services and outpatient X-rays. Diagnostic procedures and tests require a copay of $0 to $100, diagnostic radiological services have a copay of up to $300, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Home health services are covered by Humana Gold Plus H0028-062 (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H0028-062 (HMO) plan, as none of the sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy, are covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Humana Gold Plus H0028-062 (HMO) with prior authorization, though additional days beyond Medicare-covered limits are not covered. Under this plan, there is no coinsurance, but you will pay a $10 copay for days 1 to 20 and a $218 copay for days 21 to 100.
Other Services See details
Humana Gold Plus H0028-062 (HMO) partially covers Other Services, offering acupuncture for a $30 copay and no coinsurance, alongside meal benefits and over-the-counter items with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered.
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