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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 2026, 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 2026.
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 $71.00. 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 $4200.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost as little as a $5 copay for a one-month supply, with no copay required for a three-month supply when filled through preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply, or a three-month supply for $131 through preferred mail order. For higher-tier medications, Tier 4 non-preferred drugs require a 48% coinsurance for both one-month and three-month supplies. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply across standard pharmacies, preferred mail order, and standard mail order.
Additional Benefits
The Humana Gold Plus Giveback H0028-065 (HMO) plan offers robust coverage with no copay and no coinsurance for primary care physician visits, preventive services, and routine home health care. Specialist visits and physical therapy require a $30 copay, while standard diagnostic lab work and outpatient X-rays feature no copay. If hospital care is required, inpatient acute stays have a $375 daily copay for the first seven days, with no copay for subsequent days. Supplemental benefits include dental and vision coverage, featuring no copays for routine eye exams, up to $150 for eyewear, and mostly no copays or coinsurance for dental care up to a $3,500 annual limit. Routine hearing exams and over-the-counter hearing aids also require no copay, while prescription hearing aids carry copays ranging from $699 to $999. For durable medical equipment and dialysis services, members will generally pay a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Plus Giveback H0028-065 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. Acute stays require a $375 daily copay for days 1-7 (with no copay for days 8 and beyond), and psychiatric stays require a $334 daily copay for days 1-7 (with no copay for days 8-90). Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus Giveback H0028-065 (HMO) with no coinsurance, including ambulatory surgical center and blood services with no copay. Other covered services require a copay, ranging from $0 to $300 for outpatient hospital services, $375 per stay for observation services, and $30 to $35 for outpatient substance abuse sessions.
Partial Hospitalization See details
Humana Gold Plus Giveback H0028-065 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus Giveback H0028-065 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services to health-related locations are not covered.
Emergency Services See details
Humana Gold Plus Giveback H0028-065 (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 are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by Humana Gold Plus Giveback H0028-065 (HMO), featuring no copay and no coinsurance for primary care physician visits, though podiatry and chiropractic services are not covered. Specialist visits, physical therapy, occupational therapy, and mental health services require a $30 copay and no coinsurance, while telehealth services range from a $0 to $65 copay with no coinsurance.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus Giveback H0028-065 (HMO) with no copay and no coinsurance for an annual physical exam, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs. Sub-services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
Humana Gold Plus Giveback H0028-065 (HMO) covers routine hearing exams and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams require a $30 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $699 to $999 and no coinsurance for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus Giveback H0028-065 (HMO) with no copay, no coinsurance, and no deductible, though prior authorization is required. The plan covers one routine eye exam and up to $150 yearly for contact lenses or eyeglasses (lenses and frames), but other eye exams, standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Giveback H0028-065 (HMO) partially covers dental services up to a $3,500 annual limit, offering most preventive and comprehensive services with no copay and no coinsurance, while prosthodontics require 30% coinsurance and no copay. Medicare-covered dental services have a $30 copay and no coinsurance, but fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H0028-065 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus Giveback H0028-065 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus Giveback H0028-065 (HMO) with a 20% coinsurance and no copay for durable medical equipment (DME) and prosthetics, and a 15% coinsurance with no copay for medical supplies. Diabetic supplies have a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus Giveback H0028-065 (HMO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests have a copay of $0 to $65, diagnostic radiological services start at a $0 copay, and therapeutic radiological services have a minimum copay of $30.
Home Health Services See details
Humana Gold Plus Giveback H0028-065 (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus Giveback H0028-065 (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H0028-065 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus Giveback H0028-065 (HMO), featuring acupuncture for a $30 copay and no coinsurance, up to 20 treatments per year. Over-the-counter (OTC) items and chronic illness meal benefits are also covered with no copay and no coinsurance, though some other services are not covered.
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