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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 2025, 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 2025.
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 $5.00. 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 $2950.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, for preferred generic drugs, you'll pay an $8 copay at preferred pharmacies or through mail order, and a $20 copay at standard pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus H0028-074 (HMO) plan offers coverage for a wide range of services with varying costs. Inpatient hospital stays have a copay, while outpatient services, including primary care and preventive services, often have no copay or a low copay. The plan also includes coverage for hearing, vision, and dental services, with specific copays and coinsurance amounts. This plan provides coverage for emergency services, ambulance services, and home health services, as well as other benefits such as home infusion, dialysis, and medical equipment. Members will have a $195 copay for inpatient psychiatric care for days 1-6, and a $630 copay for air ambulance services. Other services such as acupuncture and OTC items are also covered, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care, with a $195 copay for days 1-6 and no copay for days 7-90, as well as no copay for additional days 91-999 for acute care, while non-Medicare-covered stays and upgrades for acute care are not covered. Inpatient Hospital Psychiatric care has a $195 copay for days 1-6 and no copay for days 7-90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $0 and $195, observation services with a $195 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0028-074 (HMO) plan, with a $100 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0028-074 (HMO) plan, with no coinsurance. Medicare-covered ground ambulance services have a $315 copay, and Medicare-covered air ambulance services have a $630 copay, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Humana Gold Plus H0028-074 (HMO) plan. Emergency Services has a $140 copay, while Urgently Needed Services has a $65 copay; both have no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay, with no coinsurance.
Primary Care See details
The Humana Gold Plus H0028-074 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, and mental health specialty services with a $25 copay for individual or group sessions. The plan also covers podiatry services, other health care professionals (copay varies), psychiatric services with a $25 copay for individual or group sessions, physical therapy, and speech-language pathology services with a $25 copay, additional telehealth benefits (copay varies), and opioid treatment program services with a $25 copay. Routine chiropractic care is not covered.
Preventive Services See details
The Humana Gold Plus H0028-074 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, as well as kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are also covered with no copay.
Hearing Services See details
The Humana Gold Plus H0028-074 (HMO) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $699 and $999, and OTC hearing aids are covered up to $50 every three months.
Vision Services See details
The Humana Gold Plus H0028-074 (HMO) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay; eyewear has a $100 maximum plan benefit per year with no copay.
Dental Services See details
The Humana Gold Plus H0028-074 (HMO) plan covers Medicare Dental Services with a $25 copay, and other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Restorative Services and Prosthodontics (fixed) have a 30-40% coinsurance, while Prosthodontics (removable) has a 30% coinsurance, all with no copay. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-074 (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay for some services, and coinsurance for some radiological services. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $195, Therapeutic Radiological Services have a copay up to $15 and coinsurance up to 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-074 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H0028-074 (HMO) plan. For days 1-20, there is a $20 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H0028-074 (HMO) plan covers acupuncture with a $25 copay, and up to 20 treatments per year. Over-the-counter (OTC) items are covered up to $50 every three months, and this plan also offers nicotine replacement therapy (NRT) and Naloxone coverage. Other services such as meal benefits, and additional services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and Case Management are not covered.
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