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Humana Gold Plus H0028-070 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-070 (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 H0028-070 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-070 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in San Antonio Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-070 (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 H0028-070 (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 H0028-070 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3600.00 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 H0028-070 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy, but $20 at a standard mail pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you may have reduced premium costs. Be sure to check the plan's formulary for specific drug coverage details.
Additional Benefits
The Humana Gold Plus H0028-070 (HMO) plan offers a range of benefits with varying cost-sharing. The plan covers inpatient hospital stays with a copay, and outpatient services with copays depending on the service. Emergency, urgent, and ambulance services have copays, and primary care and home health services have no copay. This plan also includes coverage for hearing, vision, and dental services, with copays for some services. Additional benefits include coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility services, all with associated cost-sharing like copays or coinsurance. Other covered services include acupuncture, meal benefits, and over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are covered, including acute and psychiatric care. For days 1-5, the copay is $95, and there is no copay for days 6-90, and for additional days for inpatient hospital acute care, there is no copay for days 91-999. Non-Medicare-covered stays and upgrades for inpatient hospital acute, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $120, Observation Services have a $95 copay, Ambulatory Surgical Center Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay between $30 and $75, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0028-070 (HMO) plan, and requires prior authorization. You will pay a $30 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $315 copay, while transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H0028-070 (HMO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $65 copay; both have no coinsurance. 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 H0028-070 (HMO) plan covers Primary Care Physician Services with no copay. Chiropractic Services and Physician Specialist Services have a $20 copay, while Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, and Mental Health and Psychiatric Services have a $20-$30 copay. Additional Telehealth Benefits have a $0-$65 copay and Opioid Treatment Program Services have a $30-$75 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services. The plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit all have no copay.
Hearing Services See details
Hearing services include hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay of up to $599 for all types of hearing aids, but not for inner, outer, or over-the-ear hearing aids. OTC hearing aids are covered with a maximum benefit of $50 every three months.
Vision Services See details
The Humana Gold Plus H0028-070 (HMO) plan covers vision services, including eye exams with a copay between $0 and $20, and eyewear with a $0 copay, and a combined maximum plan benefit coverage amount of $250. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, and other dental services. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay, while fluoride treatment and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-070 (HMO) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with varying copays and coinsurance. Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $75, lab services have no copay, and outpatient X-ray services have no copay. Diagnostic Radiological Services have a maximum copay of $325, while Therapeutic Radiological Services have a maximum copay of $20 and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-070 (HMO) plan with no copay and no coinsurance. However, 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 specify the cost sharing, such as copay or coinsurance. However, the plan states that the following services are not covered: 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 and a doctor's referral. You will pay a copay of $20 for days 1-20, and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H0028-070 (HMO) plan covers acupuncture with a $20 copay, up to 20 treatments per year, and meal benefits with no copay. Over-the-counter items are covered up to $50 every three months, and this plan also offers nicotine replacement therapy and Naloxone as a Part C OTC benefit. Other services such as Early and Periodic Screening, Diagnostic, and Treatment Services, and others are not covered.
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