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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.
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 $2550.00 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 features an Enhanced Alternative drug benefit with no prescription drug deductible, allowing your coverage to start immediately. During the initial coverage phase, you will pay an 8 dollar copay for Tier 1 preferred generics at standard pharmacies and preferred mail, while Tier 2 standard generics require a 47 dollar copay. For higher-tier medications, you will pay a 50 percent coinsurance for Tier 3 preferred brands and a 33 percent coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach 2,100 dollars, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D drugs. Additionally, those who qualify for the low-income subsidy can have their Part D premium reduced to no cost. This plan offers a clear path to managing your medication costs through structured copays and coinsurance.
Additional Benefits
The Humana Gold Plus H0028-074 (HMO) plan offers comprehensive medical coverage featuring no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $195 daily copay for the first six days and no copay for days seven through ninety, while emergency room visits carry a $150 copay. Outpatient hospital services require no coinsurance and feature copays ranging from $0 to $250. Supplemental benefits include dental coverage up to a $3,000 annual limit, with no copay for most preventive care and 30% to 40% coinsurance for restorative services. Routine vision and hearing exams are covered with no copay, and members receive a $350 annual allowance for select eyewear. Additionally, the plan covers over-the-counter items and diagnostic lab work with no copay.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Humana Gold Plus H0028-074 (HMO) with a $195 copay per day for days 1 to 6, no copay for days 7 to 90, and no coinsurance. Non-Medicare-covered stays and upgrades are not covered for acute care, and additional days and non-Medicare-covered stays are not covered for psychiatric care.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H0028-074 (HMO) with no coinsurance, including a $0 to $250 copay for outpatient hospital services and a $195 copay per stay for observation services. There is no copay for ambulatory surgical center and blood services, while outpatient substance abuse services require a copay of $25 to $35 per session.
Partial Hospitalization See details
Humana Gold Plus H0028-074 (HMO) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Gold Plus H0028-074 (HMO) partially covers Ambulance and Transportation Services, requiring no coinsurance alongside a $335 copay for ground ambulance services and a $630 copay for air ambulance services. Transportation services to both plan-approved and any health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H0028-074 (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 are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are each covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-074 (HMO) covers primary care physician visits with no copay and no coinsurance. Other professional, telehealth, and therapy services are covered with no coinsurance and copays ranging from $0 to $65, though chiropractic benefits are only partially covered since routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus H0028-074 (HMO) with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, and glaucoma screenings. However, several additional services are not covered, such as health education, weight management, nutritional/dietary benefits, and in-home support.
Hearing Services See details
Humana Gold Plus H0028-074 (HMO) covers hearing exams for a $15 copay and routine exams, fitting evaluations, and OTC hearing aids with no copay, all with no coinsurance. Prescription hearing aids are partially covered with a copay between $699 and $999 and no coinsurance, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Gold Plus H0028-074 (HMO) partially covers vision services with no coinsurance, featuring a $0 to $15 copay for eye exams (with no copay for annual routine exams) and no copay for select eyewear up to a $350 annual limit. Contact lenses and complete eyeglasses are covered, but separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H0028-074 (HMO) up to a $3,000 annual maximum, excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Most covered preventive and surgical services require no copay and no coinsurance, while Medicare-covered dental has a $15 copay and no coinsurance, and restorative and prosthodontic services have no copay and 30% to 40% coinsurance.
Home Infusion bundled Services See details
Humana Gold Plus H0028-074 (HMO) covers home infusion bundled services, which require prior authorization and step therapy. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H0028-074 (HMO) covers dialysis services with 20% coinsurance and no copay, although prior authorization is required.
Medical Equipment See details
Medical Equipment is covered by Humana Gold Plus H0028-074 (HMO), including durable medical equipment and medical supplies for a 15% coinsurance and no copay. Prosthetic devices require a 20% coinsurance and no copay, while diabetic supplies have a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-074 (HMO) covers diagnostic and radiological services, requiring prior authorization for all services. Lab services and outpatient X-rays have no copay, diagnostic procedures carry a $0 to $150 copay, diagnostic radiology carries a $0 to $300 copay, and therapeutic radiology requires a $15 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus H0028-074 (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0028-074 (HMO) indicates that some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered in practice. As these services are not covered, there are no copay or coinsurance benefits available for them.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-074 (HMO) covers Skilled Nursing Facility (SNF) services with a $20 copay for days 1 to 20, a $218 copay for days 21 to 100, and no coinsurance, with prior authorization required. This benefit is partially covered, as additional 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 for 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.
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