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Humana Gold Plus H0292-002 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0292-002 (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 H0292-002 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0292-002 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Northern Kentucky Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0292-002 (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 H0292-002 (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 H0292-002 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.00. 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 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 $4300.00 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 H0292-002 (HMO) prescription drug plan features an annual drug deductible of $250. For Tier 1 preferred generics, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generics are also highly affordable, costing a $5 copay for a 1-month supply and dropping to no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies and through mail order. If you require Tier 4 non-preferred drugs or Tier 5 specialty drugs, you will pay a 50% coinsurance and 30% coinsurance respectively. This plan structure provides clear cost-sharing options to help you manage your prescription medication expenses.
Additional Benefits
The Humana Gold Plus H0292-002 (HMO) plan offers robust coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. Specialists are accessible with a $40 copay, while inpatient hospital stays require a daily copay of $395 for the first few days before transitioning to no copay for longer stays. Outpatient services and emergency visits are also covered with fixed copays and no coinsurance, ensuring predictable costs for major medical needs. This plan also features valuable routine benefits, including dental care up to a $2,000 annual limit and vision coverage up to a $250 annual limit, both with no copay for routine services. Additionally, members benefit from no copay on routine hearing exams, up to 36 no-copay one-way transportation trips to approved locations, and no copay for over-the-counter items. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H0292-002 (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $395 daily copay for days 1 to 6 of acute stays (no copay for days 7 and beyond) and a $395 daily copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Humana Gold Plus H0292-002 (HMO) covers outpatient services with no coinsurance, though prior authorization is required. Outpatient hospital services carry a $0 to $325 copay, observation services have a $395 copay per stay, and substance abuse sessions cost a $35 copay, while ambulatory surgical center and blood services require no copay.
Partial Hospitalization See details
Humana Gold Plus H0292-002 (HMO) covers partial hospitalization with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H0292-002 (HMO) covers emergency ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved health-related locations, though trips to any health-related location are not covered.
Emergency Services See details
Humana Gold Plus H0292-002 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0292-002 (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Other services like physical therapy, mental health, and telehealth feature copays ranging from $0 to $50 with no coinsurance; however, chiropractic services are only partially covered (routine and other chiropractic services are not covered), and podiatry is not covered.
Preventive Services See details
Humana Gold Plus H0292-002 (HMO) covers preventive services, including annual physical exams, kidney education, glaucoma screenings, and a memory fitness benefit, with no copay and no coinsurance. Additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and therapeutic massage. Other non-covered services include medication reconciliation, re-admission prevention, wigs, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus H0292-002 (HMO) covers hearing services with no deductible, offering Medicare-covered exams for a $40 copay and no coinsurance, and routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999—with inner ear, outer ear, and over the ear types not covered—while over-the-counter hearing aids are covered with no copay or coinsurance.
Vision Services See details
Humana Gold Plus H0292-002 (HMO) vision services are partially covered with no coinsurance, featuring a $0 to $40 copay for eye exams and no copay for covered eyewear up to a $250 annual limit. One routine eye exam and one pair of contact lenses or eyeglasses (lenses and frames) are covered yearly, but other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0292-002 (HMO) dental services are partially covered, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $2,000 annual limit. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H0292-002 (HMO) with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and up to 20% coinsurance (ranging from no coinsurance to 20%), while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H0292-002 (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H0292-002 (HMO) covers durable medical equipment and prosthetics with a 20% coinsurance and no copay, subject to prior authorization. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H0292-002 (HMO) covers diagnostic and radiological services, both requiring prior authorization. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $105 copay for tests, while radiological services range from no copay for outpatient X-rays to a minimum $30 copay and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Humana Gold Plus H0292-002 (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0292-002 (HMO) covers Cardiac Rehabilitation Services with no coinsurance and requires prior authorization. Some services are covered, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus H0292-002 (HMO) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Humana Gold Plus H0292-002 (HMO) covers acupuncture with a $40.00 copay and no coinsurance for up to 20 treatments per year, alongside over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while other additional services in this category are not covered.
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