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Humana Gold Plus H0028-075 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-075 (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 H0028-075 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0028-075 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Front Range. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H0028-075 (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 H0028-075 (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 H0028-075 (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 $3.00. 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 $250.00 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 $6750.00 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 H0028-075 (HMO) plan has a $250 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, if you use a standard pharmacy, you'll pay a $10 copay for Tier 1 drugs, a $47 copay for Tier 2 drugs, and 43% coinsurance for Tier 3 drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H0028-075 (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, and outpatient services with varying copays. Preventative services, such as an annual physical exam, are covered with no copay, as are many vision and dental services. This plan also provides coverage for emergency services, ambulance services, and a range of therapies, such as primary care, mental health, and physical therapy, all with copays. Additional benefits include hearing exams, prescription hearing aids, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by Humana Gold Plus H0028-075 (HMO), including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-6, there is a $375 copay, and for days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute, and additional days and Non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $375, observation services with a $375 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $50 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $100 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Gold Plus H0028-075 (HMO) plan. Medicare-covered ground ambulance services have a $315 copay, and Medicare-covered air ambulance services have a $630 copay, but there is no coinsurance. 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 by Humana Gold Plus H0028-075 (HMO). Emergency Services has a $125 copay, Urgently Needed Services has a $55 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Gold Plus H0028-075 (HMO) plan covers primary care physician services with no copay and chiropractic services with a $20 copay, as well as occupational therapy services with a $45 copay. Specialist services have a $50 copay, while mental health and psychiatric services have a $50 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $45 copay, and additional telehealth benefits have a copay ranging from $0 to $55. Opioid treatment program services have a $50 copay.
Preventive Services See details
The Humana Gold Plus H0028-075 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and several other services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) covered with a copay between $699 and $999. OTC hearing aids are covered with a maximum benefit of $50 every three months.
Vision Services See details
The Humana Gold Plus H0028-075 (HMO) plan covers vision services including eye exams with a copay of $0-$50 and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, both with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $50 copay, and other dental services with a maximum benefit of $2500 per year. 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 fixed), and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H0028-075 (HMO) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H0028-075 (HMO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies - Non-Medicare benefit with coinsurance, and Diabetic Equipment with varying cost sharing. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Humana Gold Plus H0028-075 (HMO) plan covers diagnostic and radiological services, including Diagnostic Procedures/Tests with a copay between $0 and $100, and Lab Services with no copay. Diagnostic Radiological Services have a copay up to $375, Therapeutic Radiological Services have a coinsurance up to 20% and a copay up to $35, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-075 (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 not covered by the Humana Gold Plus H0028-075 (HMO) plan. Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H0028-075 (HMO) plan, with a $10 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H0028-075 (HMO) plan covers acupuncture with a $50 copay, and covers over-the-counter items with a maximum benefit of $50 every three months. The plan also covers a meal benefit with no copay. However, several other services are not covered.
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