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Humana Gold Plus Giveback H0028-063 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H0028-063 (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 Giveback H0028-063 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus Giveback H0028-063 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Denver. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus Giveback H0028-063 (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 Giveback H0028-063 (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 Giveback H0028-063 (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 $76.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5400.00 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 Giveback H0028-063 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, in the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy, and 47% coinsurance for preferred brand drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus Giveback H0028-063 (HMO) plan offers a range of benefits, including inpatient hospital stays with a $410 copay for the first six days, outpatient services with varying copays, and ambulance services with copays of $315 for ground and $630 for air. The plan also covers primary care and specialist visits, preventive services with no copay, and hearing and vision services, with copays and maximum benefits. Additional benefits include dental services with a $1750 annual maximum, home infusion services, and medical equipment with coinsurance. The plan also covers diagnostic and radiological services, home health services with no copay, and skilled nursing facility stays with varying copays. Other services like acupuncture and a meal benefit are also available, but some services like transportation and certain dental, vision, and hearing services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $410 per admission for days 1-6 for acute care and psychiatric, and no copay for days 7-90. Additional days for inpatient hospital-acute have no copay, while non-Medicare covered stays and upgrades for inpatient hospital-acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $410, observation services with a $410 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $45 copay for both individual and group sessions, and outpatient blood services with no copay. All of these services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Gold Plus Giveback H0028-063 (HMO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a $630 copay; there is no coinsurance for either service. 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 Giveback H0028-063 (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The Humana Gold Plus Giveback H0028-063 (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, and Occupational Therapy Services with a $45 copay. The plan also covers Physician Specialist Services with a $45 copay, Mental Health Specialty Services with a $45 copay, and Physical Therapy and Speech-Language Pathology Services with a $45 copay. The plan also covers Additional Telehealth Benefits with a copay between $0 and $55, and Opioid Treatment Program Services with a $45 copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $45 copay, while routine hearing exams have no copay and are limited to one visit per year. Fitting/Evaluation for Hearing Aids has no copay. Prescription hearing aids (all types) are covered with a copay between $299 and $899, limited to two visits per year, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
The Humana Gold Plus Giveback H0028-063 (HMO) plan covers vision services, including routine eye exams with a copay of $0 - $45, and eyewear with a maximum plan benefit of $250 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus Giveback H0028-063 (HMO) plan covers dental services, with a maximum benefit of $1750 per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus Giveback H0028-063 (HMO) plan, which includes coverage for Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus Giveback H0028-063 (HMO) plan, but require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices, Medical Supplies, and Diabetic Supplies also have a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $55, and lab services with no copay. Radiological services include coverage for diagnostic and therapeutic radiological services. Outpatient X-ray services have no copay, while therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus Giveback H0028-063 (HMO) 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 the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required, and there is a copay for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus Giveback H0028-063 (HMO) plan, with a copay of $10 for days 1-20 and $203 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 includes acupuncture and a meal benefit. Acupuncture has a $45 copay and requires prior authorization, while the meal benefit has no copay and also requires prior authorization. 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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