A non-government entity
Humana Gold Plus H0028-072 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-072 (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 H0028-072 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-072 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Fort Bend, Harris and Jefferson counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-072 (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 H0028-072 (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 H0028-072 (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 $1.00. 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 $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:
Sign up for Humana Gold Plus H0028-072 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H0028-072 (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, featuring no copay for a 3-month supply via preferred mail order and standard pharmacy copays starting at $5. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, while 3-month supplies range from $131 to $141 depending on your chosen pharmacy service. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 48% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance. These clear cost-sharing tiers help you easily budget your annual medication expenses under this Humana Medicare Advantage plan.
Additional Benefits
The Humana Gold Plus H0028-072 (HMO) plan offers comprehensive coverage for core medical services, featuring no copay for primary care doctor visits and a $15 copay for specialists. Inpatient hospital stays require a $350 copay per admission with no coinsurance, while outpatient hospital services range from no copay to a $200 copay. Urgent care visits carry a $65 copay, and emergency room services require a $150 copay which is waived upon immediate hospital admission. Members also enjoy valuable extra benefits, such as no copay for routine vision exams and eyewear up to a $450 annual limit, alongside preventive dental care with no copay up to a $3,000 yearly maximum. The plan includes up to 60 one-way transportation trips to approved locations with no copay, as well as routine hearing exams and over-the-counter hearing aids with no copay. Durable medical equipment is covered with a 20% coinsurance and no copay, while home health services are available with no copay and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus H0028-072 (HMO) covers inpatient acute and psychiatric hospital stays with a $350 copay per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H0028-072 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $200 copay for outpatient hospital services, a $350 copay per stay for observation services, and no copay for ambulatory surgical center and blood services. Outpatient substance abuse individual and group sessions are also covered with a $20 to $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H0028-072 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus H0028-072 (HMO), featuring a $335 copay and no coinsurance for both ground and air ambulance services. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H0028-072 (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 with 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 H0028-072 (HMO) partially covers primary care services with no coinsurance, offering no copay for primary care physician visits and a $15 copay for specialists. While physical therapy ($25 copay) and mental health services ($20 copay) are covered, podiatry and certain chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H0028-072 (HMO) covers preventive services, such as annual physical exams, kidney disease education, glaucoma screenings, and memory fitness, with no copay and no coinsurance. These benefits are partially covered because health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H0028-072 (HMO), featuring Medicare-covered exams for a $15 copay and no coinsurance, alongside routine exams, fitting evaluations, and OTC hearing aids for no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $599, excluding inner ear, outer ear, and over-the-ear prescription hearing aids.
Vision Services See details
Humana Gold Plus H0028-072 (HMO) provides partially covered vision services with no deductibles and no coinsurance, featuring a copay ranging from no copay to $15 for eye exams and no copay for eyewear. Covered benefits include one routine eye exam and eyewear (contact lenses or eyeglasses) up to a $450 yearly limit, while other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-072 (HMO) partially covers dental services with a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $3,000 annual maximum. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0028-072 (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-072 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H0028-072 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-072 (HMO) covers diagnostic and radiological services, with prior authorization required. Lab and outpatient X-ray services have no copay, diagnostic procedures range from a $0 to $150 copay with no coinsurance, and therapeutic radiological services require a minimum $15 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus H0028-072 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-072 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, but prior authorization is required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a $20 copay.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-072 (HMO) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus H0028-072 (HMO) partially covers other services, providing acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. Some sub-services, specifically Other 1, Other 2, and Other 3, are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved