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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 2025, 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 4.5 out of 5 stars in 2025.
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 $16.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. 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 $4500.00 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) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For generic drugs, you can expect to pay a $5 copay at a standard or preferred mail pharmacy, or a $20 copay at a standard mail pharmacy. Preferred brand drugs have a 43% coinsurance, while non-preferred drugs have a 30% coinsurance. 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 H0292-002 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary. The plan covers primary care, preventive, hearing, vision, and dental services, often with no copay or a small copay. Additional benefits include ambulance services, emergency services, and transportation with a copay. The plan also covers home health, skilled nursing, and home infusion with varying cost-sharing. Other services include acupuncture, OTC items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $395 copay for days 1-6, and no copay for days 7-90, with no coinsurance; additional days (91-999) have no copay or coinsurance. Inpatient Hospital Psychiatric has a $395 copay for days 1-5, and no copay for days 6-90, with no coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $325, observation services with a $395 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services include individual sessions with a copay between $40 and $100, and group sessions with a copay between $40 and $100. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H0292-002 (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0292-002 (HMO) plan. Ground and air ambulance services have a copay of $315, and transportation services to a plan-approved health-related location have no copay for up to 36 one-way trips per year, while 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 under the Humana Gold Plus H0292-002 (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The Humana Gold Plus H0292-002 (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, and Occupational Therapy Services with a copay between $10 and $40. This plan also covers Physician Specialist Services with a $40 copay and Mental Health Specialty Services with a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a copay between $10 and $40, while Additional Telehealth Benefits have a copay between $0 and $55. Opioid Treatment Program Services are covered with a copay between $40 and $100.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services, including Fitness Benefit, with no copay. Other services like Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $40 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with a maximum benefit of $75 every three months. Prescription hearing aids are partially covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $40, and routine eye exams have no copay. Eyewear includes contact lenses and eyeglasses (lenses and frames) with no copay, and a combined maximum of $250 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $40 copay, and Other Dental Services. Other services include oral exams and dental x-rays with no copay, and prophylaxis cleaning with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit of $2000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H0292-002 (HMO) plan, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0292-002 (HMO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
For Humana Gold Plus H0292-002 (HMO), medical equipment, prosthetics, and diabetic equipment are covered. Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $105, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $350, Therapeutic Radiological Services have a copay of up to $30 and a coinsurance of 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 H0292-002 (HMO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H0292-002 (HMO) plan, with a copay of $10 for days 1-20, and a copay of $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Gold Plus H0292-002 (HMO) plan covers acupuncture with a $40 copay, and covers Over-the-Counter (OTC) items up to $75 every three months. The plan also covers a meal benefit with no copay. Other services such as Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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