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Humana Gold Plus H0292-003 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0292-003 (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 H0292-003 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H0292-003 (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 H0292-003 (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 H0292-003 (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 H0292-003 (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 $6.00. 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 $4950.00 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 H0292-003 (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 the pharmacy you use. For preferred generic drugs, you will pay a $5 copay at preferred mail order pharmacies and a $20 copay at standard mail order pharmacies. For standard generic drugs, you will pay a $47 copay. For preferred brand drugs, you'll pay 43% coinsurance, and for non-preferred drugs, you'll pay 30% coinsurance. Once your total yearly drug costs reach $2000, you will enter the catastrophic coverage phase, and pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H0292-003 (HMO) plan offers a range of benefits, including inpatient hospital stays with a $400 copay for the first few days, and no copay after that. Outpatient services have varying copays, and emergency services have a $125 copay. Primary care visits have no copay, and specialist visits have a $40 copay. This plan also includes preventive services with no copay, and hearing and vision services with some copays. Dental services have no copays for many services. The plan covers home health services with no copay, and skilled nursing facility stays with copays. Additionally, the plan offers coverage for ambulance services, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include acute and psychiatric care, with a $400 copay for days 1-5 for acute care and days 1-4 for psychiatric care, and no copay for days 6-90 for acute care, and days 5-90 for psychiatric care. Additional days for acute care have no copay, while non-Medicare-covered stays and upgrades for acute care are not covered, and additional days and non-Medicare-covered stays for psychiatric care are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $300, observation services with a $400 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $40 and $100 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, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H0292-003 (HMO) plan. Ground and Air Ambulance Services each have a $315 copay, with no coinsurance, 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 this plan. For Emergency Services, the copay is $125, and there is no coinsurance. For Urgently Needed Services, the copay is $55, and there is no coinsurance. For Worldwide Emergency Services, the copay is $125 for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, and there is no coinsurance.
Primary Care See details
The Humana Gold Plus H0292-003 (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. The plan also covers physician specialist services with a $40 copay, mental health specialty services with a $40 copay, and physical therapy and speech-language pathology services with a copay between $10 and $40. Additional telehealth benefits range from no copay to a $55 copay, and opioid treatment program services have a copay between $40 and $100.
Preventive Services See details
Preventive Services include no copay for Medicare-covered services, annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, and wigs for hair loss related to chemotherapy, with a maximum plan benefit coverage amount of $500. Additional preventive services, including additional sessions of smoking and tobacco cessation counseling and fitness benefits, are covered, but require a copay.
Hearing Services See details
The Humana Gold Plus H0292-003 (HMO) plan covers hearing exams with a $40 copay, and routine hearing exams with no copay. Prescription hearing aids are covered, with a copay between $399 and $999, and OTC hearing aids are covered up to $100 every three months. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Humana Gold Plus H0292-003 (HMO) offers vision services including eye exams with a copay of $0-$40 and eyewear with a combined maximum of $200 per year for contact lenses and eyeglasses, with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H0292-003 (HMO) plan covers dental services including oral exams, dental x-rays, other diagnostic dental services, cleaning, other preventive services, restorative services, endodontics, periodontics, prosthodontics, fixed, and oral and maxillofacial surgery, all with no copay. Medicare dental services have a $40 copay. Fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H0292-003 (HMO) plan, but require prior authorization. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a coinsurance between 10% and 20% with no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and radiological services, are covered under the Humana Gold Plus H0292-003 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $105, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $700, and Therapeutic Radiological Services have a coinsurance of at least 20% and a copay of at least $35. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0292-003 (HMO) plan with no copay and no coinsurance, but 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. Specifically, 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 by the Humana Gold Plus H0292-003 (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214, with no coinsurance.
Other Services See details
The Humana Gold Plus H0292-003 (HMO) plan covers acupuncture with a $40 copay, and up to 20 treatments per year with prior authorization required. Over-the-counter (OTC) items are covered with a $100 maximum benefit every three months, including nicotine replacement therapy and Naloxone. The plan also provides a meal benefit with no copay for a chronic illness with prior authorization required, but other services, including Early and Periodic Screening, and Private Duty Nursing Services are not covered.
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