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Humana Gold Plus H0028-071 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-071 (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 H0028-071 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-071 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in El Paso and Hudspeth counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-071 (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 H0028-071 (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 H0028-071 (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 H0028-071 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you may pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, and a $20 copay at a standard mail pharmacy. You will enter the catastrophic coverage phase after your total drug costs reach $2000, at which point you will pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H0028-071 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services, including primary care, specialist visits, and mental health, have copays ranging from $0-$120. Emergency services, ambulance services, and transportation have copays as well. Preventive, hearing, and vision services are covered under this plan. Dental services, home health, and other services such as acupuncture and OTC items are also included. The plan covers home infusion and dialysis services, and has a coinsurance for medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $120 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute has 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 are covered under this plan, including outpatient hospital services with a copay between $0 and $120, observation services with a $95 copay, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services are covered with a copay between $20 and $100 for individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H0028-071 (HMO) plan, with a $20 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services and transportation to health-related locations. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance; transportation services to plan-approved health-related locations have no copay for up to 26 one-way trips per year. 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 H0028-071 (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $65 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $140 copay. There is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus H0028-071 (HMO) plan covers primary care physician services with no copay, and covers chiropractic, occupational therapy, specialist, mental health, psychiatric, physical therapy, speech-language pathology, telehealth, and opioid treatment services, all with a copay of $20, and requiring prior authorization and/or a referral. Podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus H0028-071 (HMO) plan covers preventive services with no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additional preventive services and kidney disease education also have no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
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 $599 for prescription hearing aids (all types), but not for inner ear, outer ear, 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 H0028-071 (HMO) plan covers vision services, including routine eye exams with a copay of $0-$20, and eyewear with no copay and a combined maximum of $200 per year for contact lenses and eyeglasses (lenses and frames), but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H0028-071 (HMO) plan covers dental services, including 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 oral and maxillofacial surgery, with no copay for many services. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0028-071 (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance, while Prosthetic Devices have a 20% coinsurance and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $95, Lab Services with no copay, Diagnostic Radiological Services with a maximum copay of $325, Therapeutic Radiological Services with a maximum copay of $20 and a 20% coinsurance, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-071 (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization and referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H0028-071 (HMO) plan, with a $20 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under "Other Services," acupuncture is covered with a $20 copay, and a limit of 20 treatments per year, while over-the-counter (OTC) items are covered up to $50 every three months. The plan also covers a meal benefit with no copay, and meals are for a chronic illness. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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