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Humana Gold Plus H1951-028 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1951-028 (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 H1951-028 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1951-028 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Washington and St. Tammany Parishes. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1951-028 (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 H1951-028 (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 H1951-028 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $22.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4975.00 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 H1951-028 (HMO) plan has an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $10 copay for preferred generic drugs at a standard pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H1951-028 (HMO) plan offers comprehensive coverage with a variety of copays depending on the service. Inpatient hospital stays have a copay, while many outpatient services, primary care visits, and preventive services have no copay. The plan also includes coverage for emergency services, ambulance services, vision, dental, and hearing services, each with specific copayments or coinsurance amounts. Home health, skilled nursing, and diagnostic services have varying cost-sharing structures, and the plan also covers medical equipment and other services like acupuncture and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $195 per day for days 1-14 and no copay for days 15-90. Additional days for Inpatient Hospital-Acute have no copay. Inpatient Hospital Psychiatric services are covered, with a copay of $168 per day for days 1-14 and no copay for days 15-90. 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 $300, Observation Services with a $195 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay between $30 and $50, and Outpatient Blood Services with no copay. Prior authorization is required for all of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1951-028 (HMO) plan, and requires prior authorization. You will have a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services and Urgent Coverage, are covered by the Humana Gold Plus H1951-028 (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 H1951-028 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $40 copay, and physical therapy and speech-language pathology services with a $20 copay. Mental health specialty services and psychiatric services have a $30 copay for individual and group sessions. Other health care professional services have a copay between $0 and $40, and additional telehealth benefits have a copay between $0 and $55. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and Fitness Benefits, Kidney Disease Education Services, and Other Preventive Services with no copay for some services. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services with Humana Gold Plus H1951-028 (HMO) include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay; prescription hearing aids (all types) have a copay between $699 and $999, while prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Humana Gold Plus H1951-028 (HMO) plan covers vision services, including eye exams with a copay between $0 and $40, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, and there is a combined maximum plan benefit of $250 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H1951-028 (HMO) plan covers a variety of dental services. Medicare Dental Services have a $40 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Prosthodontics (removable and fixed), Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery have 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 Humana Gold Plus H1951-028 (HMO), including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H1951-028 (HMO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered by Humana Gold Plus H1951-028 (HMO), including Durable Medical Equipment with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, Diabetic Supplies with 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $55, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $325, Therapeutic Radiological Services have a copay between $40 and $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1951-028 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Humana Gold Plus H1951-028 (HMO) plan, but the specific services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H1951-028 (HMO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture and a meal benefit. Acupuncture has a $40 copay per visit, and is limited to 20 treatments per year. The meal benefit has no copay.
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