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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 2026, 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 Corpus Christi and San Antonio Metro. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-070 (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 $14.00. 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 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 $3400.00 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) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. Standard mail order for these generic tiers requires a copay of $10 to $20 for a one-month supply and $30 to $60 for a three-month supply. Tier 3 preferred brand drugs have a copay of $45 for a one-month supply at standard pharmacies and preferred mail order, while a three-month supply costs $90 through preferred mail order and $135 at standard pharmacies. Tier 4 non-preferred drugs require a 50% coinsurance across all pharmacy and mail order options for both one-month and three-month supplies. Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply across all filling methods.
Additional Benefits
The Humana Gold Plus H0028-070 (HMO) plan offers affordable medical coverage with no copays for primary care visits, home health services, and essential preventive care. Specialist visits require a low $15 copay, while inpatient hospital stays feature a $95 daily copay for the first five days and no copay for days six through ninety. Emergency room visits carry a $150 copay, which is waived if you are admitted, and urgent care visits cost $65. For extra wellness support, the plan provides comprehensive dental, vision, and hearing benefits, including a $5,000 annual limit for covered dental services with no copay and a $400 yearly allowance for eyewear. Routine hearing exams and over-the-counter hearing aids also have no copay, alongside up to 100 one-way transportation trips per year to plan-approved locations with no copay. Additionally, members receive no-copay benefits for over-the-counter items and chronic illness meals.
Inpatient Hospital See details
Humana Gold Plus H0028-070 (HMO) covers inpatient hospital services with no coinsurance, featuring a $95 daily copay for days 1 to 5 and no copay for days 6 to 90. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H0028-070 (HMO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $120, observation services have a $95 copay per stay, and outpatient substance abuse services carry a copay of $20 to $35.
Partial Hospitalization See details
Humana Gold Plus H0028-070 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus H0028-070 (HMO), with a $335 copay and no coinsurance for both ground and air ambulance rides. Transportation services are partially covered, offering up to 100 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H0028-070 (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-070 (HMO) covers primary care visits with no copay and no coinsurance, and specialist visits for a $15 copay with no coinsurance. Physical, occupational, and mental health therapies require a $20 copay with no coinsurance, while podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H0028-070 (HMO) covers essential preventive services, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, and memory fitness, all with no copay and no coinsurance. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy 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, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus H0028-070 (HMO) with no coinsurance, requiring a $15 copay for Medicare-covered exams and no copay for routine exams, fitting evaluations, or over-the-counter (OTC) hearing aids. Prescription hearing aids are covered with copays ranging from $0 to $299 for up to two devices every three years, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H0028-070 (HMO) with no coinsurance and copays ranging from $0 to $15, though prior authorization and referrals are required. Covered benefits include one routine annual eye exam and up to $400 yearly for contact lenses or complete eyeglasses, while other eye exams, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-070 (HMO) partially covers dental services, providing Medicare-covered dental with a $15 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $5,000 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-070 (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B chemotherapy and other drugs are covered with 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 H0028-070 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H0028-070 (HMO) covers durable medical equipment and prosthetics with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-070 (HMO) covers diagnostic and radiological services, featuring no coinsurance and a $0 to $75 copay for diagnostic tests, alongside no copay for lab work, diagnostic radiology, and X-rays. Therapeutic radiological services require a minimum 20% coinsurance and a minimum $20 copay, with prior authorization and referrals required.
Home Health Services See details
Humana Gold Plus H0028-070 (HMO) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-070 (HMO) covers some services under its Cardiac Rehabilitation Services benefit with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and carry a $15 copay. Prior authorization and a referral are also required for these services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-070 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are covered by Humana Gold Plus H0028-070 (HMO), including acupuncture with a $15.00 copay and no coinsurance for up to 20 treatments per year. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, though some CMS-listed OTC drugs and other miscellaneous services are not covered.
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