2027 Medicare Advantage plan
Humana Gold Plus H0028-062 (HMO): 2027 benefits and costs
Humana HMO
CMS plan ID: H0028-062-0 · Plan year: 2027
Humana Gold Plus H0028-062 (HMO) is a 2027 Medicare Advantage plan offered by Humana. It is listed in Arizona.
2027 plan costs at a glance
Monthly plan premium$0.00
Drug deductible$700.00
In-network medical out-of-pocket maximum$5,999.00
- Organization
- Humana
- Plan organization
- CHA HMO, INC.
- Parent company
- Humana Inc.
- Plan type
- HMO
- Part C premium
- $0.00
- Part D premium
- $0.00
- Prescription drug coverage
- Yes
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
You must continue to pay your Medicare Part B premium.
- In-network medical deductible
- None
- In-network medical maximum
- $5,999.00
Applies to certain in-network supplemental services.
2027 benefit summary
Doctor visits and medical care
| Service | In-network | What to know |
|---|---|---|
| Primary care doctor | $0.00 copay
| |
| Specialist visit | $30.00 copay
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| Telehealth | $0.00 to $50.00 copay
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| Emergency care | $130.00 copay | |
| Urgent care | $50.00 copay | |
| Home health | $0.00 copay
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| Dialysis | 20% coinsurance
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| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
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| Other Part B drugs | 0% to 20% coinsurance
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| Kidney disease education services | $0.00 copay
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| Medicare-covered chiropractic | $15.00 copay
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| Medicare-covered foot care | $30.00 copay
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| Other health professionals | $0.00 to $30.00 copay
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Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–6: $425.00 copay per day Days 7–90: $0.00 copay per day |
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| Inpatient mental health care | $0.00 copay per stay Days 1–6: $392.00 copay per day Days 7–90: $0.00 copay per day |
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| Skilled nursing facility | Days 1–20: $10.00 copay per day Days 21–100: $221.00 copay per day |
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See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | What to know |
|---|---|---|
| Outpatient hospital care | $0.00 to $400.00 copay
| |
| Hospital observation services | $425.00 copay
| |
| Ambulatory surgical center | $0.00 to $325.00 copay
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| Outpatient blood | $0.00 copay
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Tests, imaging and laboratory services
| Service | In-network | What to know |
|---|---|---|
| Diagnostic procedures and tests | $0.00 to $175.00 copay
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| Laboratory services | $0.00 copay
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| Diagnostic radiology (CT, MRI) | $0.00 to $345.00 copay
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| Therapeutic radiology | $30.00 copay; 20% coinsurance
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| X-rays | $0.00 to $145.00 copay
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Mental health and substance use treatment
| Service | In-network | What to know |
|---|---|---|
| Partial hospitalization | $35.00 copay
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| Intensive outpatient program | $35.00 copay
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| Substance use treatment, individual sessions | $35.00 copay
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| Substance use treatment, group sessions | $35.00 copay
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| Opioid treatment program | $35.00 copay
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| Mental health, individual sessions | $35.00 copay
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| Mental health, group sessions | $35.00 copay
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| Psychiatry, individual sessions | $35.00 copay
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| Psychiatry, group sessions | $35.00 copay
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Therapy and rehabilitation
| Service | In-network | What to know |
|---|---|---|
| Occupational therapy | $35.00 copay
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| Physical and speech therapy | $35.00 copay
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| Cardiac rehabilitation | $0.00 copay
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| Intensive cardiac rehabilitation | $0.00 copay
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| Pulmonary rehabilitation | $0.00 copay
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| Supervised exercise for peripheral artery disease | $0.00 copay
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Ambulance, medical equipment and supplies
| Service | In-network | What to know |
|---|---|---|
| Ground ambulance | $325.00 copay
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| Air ambulance | $1,800.00 copay
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| Durable medical equipment | 20% coinsurance
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| Prosthetic devices | 20% coinsurance
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| Medical supplies | 20% coinsurance
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| Diabetic supplies | $0.00 copay; 10% to 20% coinsurance
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| Diabetic shoes and inserts | $10.00 copay
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| Diabetic monitors | $0.00 copay; 10% to 20% coinsurance
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Dental benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered dental | $30.00 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
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered eye exams | $0.00 to $30.00 copay
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| Routine eye examsAdditional plan benefit | $0.00 copay |
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| Medicare-covered eyewear | $0.00 copay
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| Contact lensesAdditional plan benefit | $0.00 copay |
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| Eyeglasses, lenses and framesAdditional plan benefit | $0.00 copay |
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Hearing benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered hearing exams | $30.00 copay
|
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| Routine hearing examsAdditional plan benefit | $0.00 copay |
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| Hearing aid fitting and evaluationAdditional plan benefit | $0.00 copay |
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| Prescription hearing aids (all types)Additional plan benefit | $499.00 to $725.00 copay
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| Over-the-counter hearing aidsAdditional plan benefit | $0.00 copay
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Extra benefits
| Service | In-network | What to know |
|---|---|---|
| Supplemental acupunctureAdditional plan benefit | $30.00 copay
|
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| Over-the-counter health itemsAdditional plan benefit | $0.00 copay
| |
| Limited-duration mealsAdditional plan benefit | $0.00 copay
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| Annual physical examAdditional plan benefit | $0.00 copay
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| Fitness benefitAdditional plan benefit | $0.00 copay
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Allowances and optional benefits
OTC Max Allowance
One shared limit covers the listed services, not a separate allowance for each service.
- Services sharing this allowance
- Over-the-counter health items; Over-the-counter hearing aids
- How benefits are provided
- Catalogue Purchase
- Advance choice of benefits required
- No
- Shared benefit limit
- $25.00
- How often this limit applies
- Every three months
- Shared limit on visits or trips
- No
Benefits for qualifying members
Virtual Cardiac Recovery Program
The plan must confirm eligibility, including any qualifying condition.
- 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
Prescription drug coverage
Costs shown are for initial coverage.
Drug deductible exceptions: Tier 1; Tier 2; Tier 3 are exempt from the deductible.
Standard retail costs
| Drug tier | 30 days | 100 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 | 25% | Not listed |
Mail-order and other pharmacies
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
| Drug tier | 30 days | 100 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 | 25% | Not listed |
Standard mail order costs
| Drug tier | 30 days | 100 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 | 25% | Not listed |
Long-term care pharmacy costs
| Drug tier | 31 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $0.00 |
| Tier 3Preferred Brand | 17% |
| Tier 4Non-Preferred Drug | 50% |
| Tier 5Specialty Tier | 25% |
Out-of-network pharmacy costs
| Drug tier | 30 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $0.00 |
| Tier 3Preferred Brand | 17% |
| Tier 4Non-Preferred Drug | 50% |
| Tier 5Specialty Tier | 25% |
Drug coverage rules and exceptions
Tier 1: Preferred Generic
- Drugs included in this tier
- Both Part D and Excluded Drugs
- 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
Special cost protections apply to covered insulin and recommended adult vaccines.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.