2027 Medicare Advantage plan

Humana Gold Plus H0028-037 (HMO): 2027 benefits and costs

Humana HMO

CMS plan ID: H0028-037-0 · Plan year: 2027

Humana Gold Plus H0028-037 (HMO) is a 2027 Medicare Advantage plan offered by Humana. It is listed in Texas. Use this summary to compare plan costs, medical care and extra benefits. Check the service area and official plan documents before choosing a plan.

2027 plan costs at a glance

Monthly plan premium$0.00
Drug deductible$440.00
In-network medical out-of-pocket maximum$5,350.00
Organization
Humana
Plan type
HMO
Part C premium
$0.00
Part D premium
$0.00
Prescription drug coverage
Yes

2027 benefit summary

Compare medical care and extra benefits, with network costs beside each service. A copay is a fixed dollar amount; coinsurance is a percentage of the covered cost. When both are listed, check when each applies. A range depends on the service or provider.

Doctor visits and medical care

Costs below keep in-network and out-of-network care separate. An unlisted network price does not establish coverage. Approval means the plan must authorize the service; a referral is a doctor’s direction to another provider.

Common medical services and member costs
ServiceIn-networkWhat to know
Primary care doctor

$0.00 copay

Deductible applies
No
Specialist visit

$25.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Telehealth

$0.00 to $50.00 copay

Deductible applies
No
Approval required
No
Referral required
No
Emergency care

$130.00 copay

Urgent care

$50.00 copay

Home health

$0.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Dialysis

20% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
Yes
Part B chemotherapy and radiation drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Medicare-covered acupuncture

$0.00 copay

Deductible applies
No
Approval required
No
Referral required
No
Medicare-covered chiropractic

$15.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Medicare-covered foot care

$25.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Other health professionals

$0.00 to $25.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–6: $325.00 copay per day

Days 7–90: $0.00 copay per day

Approval required
Yes
Referral required
Yes
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$0.00 copay per stay

Days 1–6: $325.00 copay per day

Days 7–90: $0.00 copay per day

Approval required
Yes
Referral required
Yes
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $0.00 copay per day

Days 21–100: $221.00 copay per day

Approval required
Yes
Referral required
Yes
Benefit period
Original Medicare

Out-of-network hospital and skilled nursing charges are not included here. Confirm them before arranging care.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkWhat to know
Outpatient hospital care

$0.00 to $300.00 copay

Deductible applies
No
Hospital observation services

$325.00 copay

Deductible applies
No
Ambulatory surgical center

$0.00 to $225.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Outpatient blood

$0.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkWhat to know
Diagnostic procedures and tests

$0.00 to $175.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Laboratory services

$0.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Diagnostic radiology (CT, MRI)

$0.00 to $360.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Therapeutic radiology

$25.00 copay; 20% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
Yes
X-rays

$0.00 to $145.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkWhat to know
Partial hospitalization

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Intensive outpatient program

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Substance use treatment, individual sessions

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Substance use treatment, group sessions

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Opioid treatment program

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Mental health, individual sessions

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Mental health, group sessions

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Psychiatry, individual sessions

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Psychiatry, group sessions

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkWhat to know
Occupational therapy

$25.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Physical and speech therapy

$25.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Cardiac rehabilitation

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Intensive cardiac rehabilitation

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Pulmonary rehabilitation

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Supervised exercise for peripheral artery disease

$20.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkWhat to know
Ground ambulance

$325.00 copay

Deductible applies
No
Approval required
Yes
Air ambulance

20% coinsurance

Deductible applies
No
Approval required
Yes
Durable medical equipment

20% coinsurance

Deductible applies
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Deductible applies
No
Approval required
Yes
Medical supplies

20% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic supplies

$0.00 copay; 10% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic shoes and inserts

$10.00 copay

Deductible applies
No
Approval required
Yes
Diabetic monitors

$0.00 copay; 10% to 20% coinsurance

Deductible applies
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered dental

$25.00 copay

Oral examsAdditional plan benefit

$0.00 copay

Dental X-raysAdditional plan benefit

$0.00 copay

Dental cleaningAdditional plan benefit

$0.00 copay

Restorative dental careAdditional plan benefit

0% to 50% coinsurance

Root canal treatment (endodontics)Additional plan benefit

0% to 50% coinsurance

Gum treatment (periodontics)Additional plan benefit

0% to 50% coinsurance

Removable dentures (prosthodontics)Additional plan benefit

50% coinsurance

Fixed dental restorations (prosthodontics)Additional plan benefit

0% to 50% coinsurance

Oral surgeryAdditional plan benefit

0% to 50% coinsurance

Other dental servicesAdditional plan benefit

50% coinsurance

Vision benefits

Vision benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered eye exams

$0.00 to $25.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Routine eye examsAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
Yes
Medicare-covered eyewear

$0.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Contact lensesAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
Yes
Eyeglasses, lenses and framesAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
Yes

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered hearing exams

$25.00 copay

Deductible applies
No
Approval required
Yes
Referral required
Yes
Routine hearing examsAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
Yes
Hearing aid fitting and evaluationAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
Yes
Prescription hearing aids (all types)Additional plan benefit

$575.00 to $750.00 copay

Deductible applies
No
Approval required
No
Referral required
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkWhat to know
Supplemental acupunctureAdditional plan benefit

$25.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Limited-duration mealsAdditional plan benefit

$0.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Annual physical examAdditional plan benefit

$0.00 copay

Deductible applies
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0.00 copay

Deductible applies
No
Approval required
No
Referral required
No

Allowances and optional benefits

Benefits for qualifying members

These benefits are not available to every member. The plan must confirm that you meet its qualifying rules.

Virtual Cardiac Recovery Program

A qualifying condition alone may not establish eligibility. The requirements and shared limits below apply to this package, not to every plan member.

Qualifying conditions
Congestive Heart Failure (CHF); Hypertension; Other 1; Other 2
Qualifying conditions
Pneumonia
Qualifying conditions
Respiratory Illnesses
All listed conditions required
No
Combination of conditions required
No
Included services
Other 1
Some package benefits are exempt from the deductible
No

Non-Emergency Medical Transportation

A qualifying condition alone may not establish eligibility. The requirements and shared limits below apply to this package, not to every plan member.

Qualifying conditions
Other 1; Other 2; Other 3
Qualifying conditions
End Stage Renal Disease (ESRD)
Qualifying conditions
Chronic Kidney Disease (CKD)
Qualifying conditions
Cancer
All listed conditions required
No
Combination of conditions required
No
Included services
Transportation to plan-approved health locations
Some package benefits are exempt from the deductible
No

Prescription drug coverage

Your drug cost depends on the medication, its tier, the pharmacy and how many days you fill. These are initial-coverage costs, not a quote for a particular prescription.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Find your medicine’s tier, then read across to its fill length. Each amount is for one prescription fill at the named pharmacy type. “Not listed” means the price is not summarized here, not that it is free or not covered.

Standard retail costs

Standard retail: initial-coverage cost per prescription fill
Drug tier30 days100 days
Tier 1Preferred Generic

$0.00

$0.00

Tier 2Generic

$0.00

$0.00

Tier 3Preferred Brand

17%

17%

Tier 4Non-Preferred Drug

50%

50%

Tier 5Specialty Tier

28%

Not listed

Mail-order and other pharmacies

The following tables use the same tier-and-fill layout, with each pharmacy type kept separate. Out-of-network pharmacy use is subject to the plan’s coverage rules and can cost more than the amounts listed.

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Preferred mail order costs

Preferred mail order: initial-coverage cost per prescription fill
Drug tier30 days100 days
Tier 1Preferred Generic

$0.00

$0.00

Tier 2Generic

$0.00

$0.00

Tier 3Preferred Brand

17%

15%

Tier 4Non-Preferred Drug

50%

50%

Tier 5Specialty Tier

28%

Not listed

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier30 days100 days
Tier 1Preferred Generic

$10.00

$30.00

Tier 2Generic

$20.00

$60.00

Tier 3Preferred Brand

17%

17%

Tier 4Non-Preferred Drug

50%

50%

Tier 5Specialty Tier

28%

Not listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier31 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$0.00

Tier 3Preferred Brand

17%

Tier 4Non-Preferred Drug

50%

Tier 5Specialty Tier

28%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier30 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$0.00

Tier 3Preferred Brand

17%

Tier 4Non-Preferred Drug

50%

Tier 5Specialty Tier

28%

Drug coverage rules and exceptions

Check that your medicine is on the plan’s list of covered drugs (formulary). Quantity limits, step therapy, approval requirements and Extra Help can affect your costs.

Tier 1: Preferred Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 2: Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 3: Preferred Brand

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 4: Non-Preferred Drug

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 5: Specialty Tier

Drugs included in this tier
Part D Drugs Only
Initial-coverage prices also apply to drugs exempt from the deductible
Yes

Covered insulin and certain recommended adult vaccines have special cost protections. Confirm how those rules apply to your prescription with Medicare or the plan.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

Texas