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Humana Gold Plus Giveback H0028-065 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H0028-065 (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 H0028-065 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus Giveback H0028-065 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Missouri. 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 H0028-065 (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 H0028-065 (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 H0028-065 (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 $56.00. 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 $250.00 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 $4150.00 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 H0028-065 (HMO) plan has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $5 copay at preferred mail and preferred pharmacies, and a $20 copay at standard mail pharmacies. For standard generic drugs, you will pay a $47 copay at all pharmacies. For preferred brand drugs, you will pay 43% coinsurance, and for non-preferred drugs, you will pay 30% coinsurance. 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 Giveback H0028-065 (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays depending on the specific service. It also covers services like emergency care, primary care, and preventive services, often with no copay or a low copay. The plan includes vision, hearing, and dental benefits, as well as home health and skilled nursing facility care, with different cost-sharing structures for each.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Humana Gold Plus Giveback H0028-065 (HMO) plan. For Inpatient Hospital-Acute, you will pay a $425 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $424 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $300, observation services with a $425 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services include a copay of $35 for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, and air ambulance services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by Humana Gold Plus Giveback H0028-065 (HMO). Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $65 copay and no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus Giveback H0028-065 (HMO) plan covers Primary Care Physician Services and Chiropractic Services with no copay, and a $40 copay for Occupational Therapy Services. Physician Specialist Services and Individual/Group Sessions for Mental Health and Psychiatric Services have a $35 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Other Health Care Professional services have a copay between $0 and $35, and Additional Telehealth Benefits have a copay between $0 and $65. Opioid Treatment Program Services have a $35 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Humana Gold Plus Giveback H0028-065 (HMO) plan covers a variety of preventive services, including an annual physical exam with no copay, and additional services like Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, modifications, or counseling services.
Hearing Services See details
Hearing services include coverage for hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $499 and $799, while OTC hearing aids are covered up to $125 every three months.
Vision Services See details
The Humana Gold Plus Giveback H0028-065 (HMO) plan covers vision services, including eye exams with a copay of $0-$35. Eyewear benefits are also covered with no copay, with a combined maximum of $150 every year for contact lenses and eyeglasses (lenses and frames), while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Prosthodontics (removable and fixed) have a 30% coinsurance and no copay. Fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance. Prior authorization is required for all Home Infusion bundled Services.
Dialysis Services See details
Dialysis Services are covered with prior authorization, and require a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 15% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay and between 10% and 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Humana Gold Plus Giveback H0028-065 (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $65, and lab services with no copay. The plan also covers diagnostic radiological services with a copay up to $350, therapeutic radiological services with a coinsurance up to 20% and a copay up to $35, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus Giveback H0028-065 (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 covered, but there is no information on the cost sharing details, and the plan does not cover any of the sub-services. This means that the plan does not cover: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is a $20 copay, and for days 21-100, there is a $203 copay, and there is no coinsurance.
Other Services See details
The Humana Gold Plus Giveback H0028-065 (HMO) plan covers acupuncture with a $35 copay, and provides Over-the-Counter (OTC) items with a maximum benefit of $125 every three months; it also covers a meal benefit with no copay. The plan does not cover Dual Eligible SNPs with Highly Integrated Services and other additional services.
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