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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 2026, 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 out of 5 stars in 2026.
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 $1.00. 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 $4450.00 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) prescription drug plan features an annual drug deductible of $250. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. If you utilize standard mail order for these tiers, your copay ranges from $10 to $20 for a 1-month supply. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply, with preferred mail order offering a reduced 3-month copay of $131. Higher-tier medications require coinsurance instead of flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance across standard pharmacies and mail-order options.
Additional Benefits
The Humana Gold Plus H0292-003 (HMO) plan offers comprehensive coverage with no deductibles for many key services, focusing primarily on predictable copayments rather than coinsurance. Members benefit from no copay for primary care visits, routine preventive care, and home health services, while specialist visits carry a $40 copay. Inpatient hospital stays require a daily copay of $400 for the first five days, and emergency room visits have a $130 copay which is waived upon admission. For supplemental care, the plan features no copay for routine dental, vision, and hearing exams, including allowances of up to $1,500 for dental services and $550 for eyewear. Specialized needs such as durable medical equipment and dialysis are covered with a 20% coinsurance and no copay, while lab services and outpatient X-rays require no copay. Additionally, members can access over-the-counter items and meal benefits with no copay, while acupuncture is available for a $40 copay.
Inpatient Hospital See details
Humana Gold Plus H0292-003 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $400 daily copay for days 1 to 5 for acute care (with no copay for days 6 and beyond) and days 1 to 4 for psychiatric care (with no copay for days 5 to 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by Humana Gold Plus H0292-003 (HMO) feature no coinsurance across all services, with outpatient hospital copays ranging from $0 to $400 and observation services requiring a $400 copay per stay. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions carry a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H0292-003 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus H0292-003 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H0292-003 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if 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 covered with a $130 copay and no coinsurance, with none of these costs counting toward a plan-level deductible.
Primary Care See details
Humana Gold Plus H0292-003 (HMO) offers primary care visits with no copay and no coinsurance, alongside specialist visits for a $40 copay and no coinsurance. Physical therapy, mental health, and telehealth services are covered with copays ranging from no copay up to $50 and no coinsurance, though podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Humana Gold Plus H0292-003 (HMO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. However, additional preventive benefits are only partially covered, with services such as health education, nutritional/dietary benefits, weight management programs, and in-home safety assessments not covered by the plan.
Hearing Services See details
Humana Gold Plus H0292-003 (HMO) hearing services feature no deductibles and no coinsurance, offering routine hearing exams, fitting evaluations, and OTC hearing aids with no copay, while Medicare-covered exams require a $40 copay. Prescription hearing aids are partially covered with a copay of $399 to $999 for up to two devices per year, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Humana Gold Plus H0292-003 (HMO) partially covers vision services with no deductibles, no coinsurance, and no copays for covered routine eye exams and select eyewear, which has a $550 annual maximum. However, other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0292-003 (HMO) partially covers dental services, offering Medicare-covered dental with a $40 copay and no coinsurance, and other dental services with no copay, no coinsurance, and a $1,500 annual limit. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H0292-003 (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H0292-003 (HMO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H0292-003 (HMO), with durable medical equipment, prosthetics, and medical supplies requiring a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H0292-003 (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures feature no coinsurance with copays from $0 to $105, while lab services and outpatient X-rays have no copays. Therapeutic radiological services require a minimum $35 copay and 20% coinsurance, and diagnostic radiological services feature copays starting at $0.
Home Health Services See details
Humana Gold Plus H0292-003 (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H0292-003 (HMO) provides coverage for Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0292-003 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus H0292-003 (HMO) covers acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, as well as over-the-counter items and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and certain other miscellaneous services are not covered.
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