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Humana Gold Plus H4007-028 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H4007-028 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H4007-028 (HMO-POS) in 2025, please refer to our full plan details page.
Humana Gold Plus H4007-028 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Puerto Rico Island Wide. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H4007-028 (HMO-POS) 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 H4007-028 (HMO-POS).
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 H4007-028 (HMO-POS), 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 $9.00. 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 $5000.00 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 H4007-028 (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, standard generic drugs have a $10 copay at a standard pharmacy, while preferred generic drugs have no copay at all. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs. This plan is an enhanced alternative plan, and the plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Humana Gold Plus H4007-028 (HMO-POS) plan offers comprehensive coverage with a variety of benefits. The plan includes coverage for inpatient and outpatient hospital services, with many services having a $0 copay. The plan also covers a range of services like primary care, preventive care, hearing, vision, and dental, often with no copay or coinsurance. Additional benefits include ambulance and transportation services, emergency services, and home health services, with varying copays and coinsurance amounts. The plan also covers services like medical equipment, diagnostic and radiological services, and cardiac rehabilitation, with specific cost-sharing details outlined in the plan. Furthermore, the plan provides coverage for acupuncture, an over-the-counter (OTC) items benefit, and a meal benefit, enhancing the overall value and support for its members.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with no copay. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $20, observation services with no copay, ambulatory surgical center services with a $20 copay, outpatient substance abuse services with a copay between $0 and $20 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
The Humana Gold Plus H4007-028 (HMO-POS) plan covers ambulance services, with a $50 copay for ground ambulance and 20% coinsurance for air ambulance. Transportation services to a plan-approved health-related location are covered with no copay, up to 36 one-way trips per year, but 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. Emergency Services have a $50 copay, Urgently Needed Services have a $10 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $50 copay.
Primary Care See details
The Humana Gold Plus H4007-028 (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, individual and group mental health and psychiatric sessions, other health care professional services, and additional telehealth benefits have no copay, and occupational therapy services, physical therapy and speech-language pathology services have a $6 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, some of which have a copay; however, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have no copay.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids are covered with a plan-specified amount of $1000 per year, and OTC hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams, with no copay, and eyewear, also with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H4007-028 (HMO-POS) covers dental services, including oral exams and dental x-rays with no coinsurance, and prophylaxis cleaning with no coinsurance. Fluoride treatment and orthodontics are not covered, and other services like restorative services, endodontics, periodontics, prosthodontics, removable, implant services, prosthodontics, fixed, and oral and maxillofacial surgery are covered with no coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H4007-028 (HMO-POS) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 19%. Other Medicare Part B drugs, as well as Medicare Part B Chemotherapy/Radiation Drugs, have a coinsurance between 0% and 19%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H4007-028 (HMO-POS) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no coinsurance, and while there is a copay, it is $0. Prosthetic devices and medical supplies have no coinsurance, and while there is a copay, it is $0. Diabetic supplies and Diabetic Therapeutic Shoes/Inserts have no coinsurance, and while there is a copay, it is $0. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $20, and lab services with no copay. Radiological services are covered with a copay of up to $20, and therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H4007-028 (HMO-POS) 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 by the Humana Gold Plus H4007-028 (HMO-POS) plan, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and there is a copay for Medicare-covered Cardiac Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. The plan requires prior authorization, and further details about the copay are available.
Other Services See details
Humana Gold Plus H4007-028 (HMO-POS) covers acupuncture with no copay, up to 20 treatments per year, and also includes an over-the-counter (OTC) items benefit with a $25 monthly maximum. The plan also includes a meal benefit with no copay, but requires prior authorization. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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