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Humana Gold Plus H0028-074 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-074 (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 H0028-074 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-074 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Arizona. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-074 (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 H0028-074 (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 H0028-074 (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2900.00 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 H0028-074 (HMO) plan offers an enhanced alternative drug benefit with no prescription drug deductible, meaning your coverage starts immediately. During the initial coverage phase, you will pay an $8 copay for tier 1 preferred generic drugs at standard pharmacies and preferred mail. For tier 2 standard generic drugs, you will pay a $47 copay at standard pharmacies and mail-order options. Tier 3 preferred brand drugs require a 50% coinsurance, while tier 4 non-preferred drugs have a 33% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus H0028-074 (HMO) plan offers robust medical coverage with many services featuring no coinsurance and no copays, including primary care physician visits and home health services. For inpatient hospital stays, members pay a $195 daily copay for days one through six, with no copays for days seven through ninety. Emergency care is accessible with a $150 copay, which is waived if admitted, while specialist visits and outpatient procedures carry low, predictable copays and no coinsurance. This plan also provides excellent supplemental benefits, including preventive dental services with no copays and comprehensive coverage up to a $3,000 annual limit. Routine vision and hearing exams feature no copays, alongside generous allowances for eyewear and over-the-counter hearing aids. Other essential benefits like diagnostic lab tests, outpatient X-rays, and over-the-counter items are also covered with no copays, helping to minimize your out-of-pocket healthcare expenses.
Inpatient Hospital See details
Humana Gold Plus H0028-074 (HMO) partially covers inpatient hospital benefits with a $195 daily copay for days 1 through 6 and no copay or coinsurance for days 7 through 90. Upgrades, non-Medicare-covered stays, and additional days for psychiatric hospitalizations are not covered.
Outpatient Services See details
Humana Gold Plus H0028-074 (HMO) covers outpatient services with no coinsurance. Copays range from no copay for ambulatory surgical center and blood services, $25 to $35 for outpatient substance abuse sessions, and up to $195 for outpatient hospital and observation services.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Humana Gold Plus H0028-074 (HMO) plan with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Humana Gold Plus H0028-074 (HMO), as transportation services are not covered. Covered ground ambulance services require a $335 copay and no coinsurance, while air ambulance services require a $630 copay and no coinsurance.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H0028-074 (HMO) with a $150 copay and no coinsurance, which is 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
Primary Care benefits are partially covered by Humana Gold Plus H0028-074 (HMO), as routine chiropractic care is not covered. The plan features no copay for primary care physician visits, while other services like specialist visits, therapy, and mental health sessions require copays ranging from $15 to $65, all with no coinsurance.
Preventive Services See details
Humana Gold Plus H0028-074 (HMO) partially covers preventive services with no copay or coinsurance for annual physicals, kidney disease education, and glaucoma screenings. While memory fitness and chemotherapy wigs are covered at no cost, other additional services—including health education, in-home safety assessments, personal emergency response systems, and nutritional counseling—are not covered.
Hearing Services See details
Humana Gold Plus H0028-074 (HMO) covers hearing exams with a $15 copay (or no copay for routine exams and fittings) and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, though inner ear, outer ear, and over-the-ear models are not covered. Over-the-counter hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H0028-074 (HMO) partially covers vision services with no coinsurance, offering eye exams for a $0 to $15 copay and covered eyewear with no copay up to a $250 annual limit. While routine eye exams, contact lenses, and complete eyeglasses are covered, standalone eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-074 (HMO) provides partially covered dental services up to a $3,000 annual limit, featuring a $15 copay and no coinsurance for Medicare dental services. Most preventive and comprehensive services require no copay and no coinsurance, while fixed and removable prosthodontics have a 30% coinsurance and no copay; fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H0028-074 (HMO), requiring prior authorization and step therapy. Covered Medicare Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-074 (HMO) plan with a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H0028-074 (HMO) covers medical equipment, including durable medical equipment (DME) with a 15% coinsurance and no copay, and prosthetics with a 15% to 20% coinsurance and no copay. Diabetic supplies require a 10% to 20% coinsurance and no copay, while diabetic shoes and inserts have a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H0028-074 (HMO) with prior authorization required. Lab services and outpatient X-rays have no copay, while diagnostic procedures carry a $0 to $150 copay with no coinsurance. Diagnostic radiology has a copay of up to $300 with no coinsurance, and therapeutic radiology requires a $15 copay and 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H0028-074 (HMO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H0028-074 (HMO) plan, as all sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage. Consequently, there are no copays or coinsurance fees for these services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-074 (HMO) covers Skilled Nursing Facility (SNF) services with a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance required. Prior authorization is required, and while a prior 3-day inpatient hospital stay is not required for admission, additional stay days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H0028-074 (HMO) partially covers Other Services, offering acupuncture with a $15 copay and no coinsurance, and over-the-counter items with no copay and no coinsurance. Meal benefits and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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