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Humana Gold Plus H3533-027 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H3533-027 (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 H3533-027 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H3533-027 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in New York City and Long Island. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H3533-027 (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 H3533-027 (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 H3533-027 (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 $20.00. 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 $425.00 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 $9350.00 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 H3533-027 (HMO) plan has a $425 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you may pay a $16 copay for preferred generic drugs at a standard pharmacy, or 31% coinsurance for preferred brand drugs. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus H3533-027 (HMO) plan offers a range of benefits with varying costs. It covers inpatient hospital stays with a $1925 copay per admission, outpatient services with copays ranging from $40 to $1075, and emergency services with a $110 copay. The plan includes no copay for primary care physician visits, preventive services such as an annual physical, and many vision and dental services. Hearing exams have a $50 copay, and prescription hearing aids have a copay between $699 and $999. Other benefits include home health services with no copay, and skilled nursing facility services with a copay after 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has a copay of $1925 per admission or stay for a Medicare-covered stay, and additional days have no copay. Inpatient Hospital Psychiatric has a copay of $1925 per admission or stay for a Medicare-covered stay, and additional days are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a copay of $50.00 - $1075.00, observation services with a $500 copay, ambulatory surgical center services with a $450 copay, and outpatient substance abuse services with a copay of $40.00 - $100.00 for individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H3533-027 (HMO) plan, but requires prior authorization. You will pay a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H3533-027 (HMO) plan. Ground and Air Ambulance Services have a $315 copay, and there is no coinsurance. 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 by the Humana Gold Plus H3533-027 (HMO) plan. Emergency Services has a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus H3533-027 (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $50 copay, and Physical Therapy and Speech-Language Pathology Services with a $35 copay. The plan also covers Mental Health Specialty Services and Psychiatric Services with a $40 copay for individual and group sessions, and Additional Telehealth Benefits with a copay between $0 and $50. Opioid Treatment Program Services are covered with a copay between $40 and $100. Podiatry Services are not covered.
Preventive Services See details
The Humana Gold Plus H3533-027 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additionally, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $50 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a copay between $699 and $999 depending on the type of hearing aid, while OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $50, and eyewear with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay.
Dental Services See details
The Humana Gold Plus H3533-027 (HMO) plan covers Medicare Dental Services with a $50 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventative dental services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H3533-027 (HMO) plan, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and a coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H3533-027 (HMO) plan. A 20% coinsurance applies for this benefit.
Medical Equipment See details
Medical Equipment is covered under the Humana Gold Plus H3533-027 (HMO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 2% coinsurance, while Prosthetic Devices have a 4% coinsurance, and Medical Supplies have a 5% coinsurance. Diabetic Supplies have a 10% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay, and a maximum copay of $100 for diagnostic procedures and tests. Lab services have no copay, while diagnostic radiological services have a copay of at most $720 with a minimum copay of $50, and therapeutic radiological services have a coinsurance of at least 20%. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H3533-027 (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 not covered under the Humana Gold Plus H3533-027 (HMO) plan. Specifically, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H3533-027 (HMO) plan, requiring prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The Humana Gold Plus H3533-027 (HMO) plan covers acupuncture with a $50 copay, and a limit of 20 treatments per year. The plan also offers a meal benefit with no copay. Other services, including over-the-counter items, are not covered.
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