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Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) H0028-007 • 2027 • Polk County, NE

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$9250.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $700.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Polk County, NE
Local Enrollment
0 beneficiaries in Polk County
Last update:

Introduction

Humana Gold Plus SNP-DE H0028-007 is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by Humana. The plan uses a Health Maintenance Organization (HMO) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $0.00 monthly premium, $0.00 medical deductible, and $9250.00 in-network maximum out-of-pocket. CMS Plan ID H0028-007 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.

You must live in Polk County, Nebraska to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Polk County. For assistance with this plan, new members can call (888)873-0686 (TTY 711).

Eligibility

Humana Gold Plus SNP-DE H0028-007 is a Medicare D-SNP plan for dual-eligible beneficiaries (Medicare and Medicaid).

Special Needs Plan Type
Dual-Eligible Special Needs Plan (D-SNP)
Medicare Requirement
Medicare Part A and Part B
Special Needs Requirement
Must qualify for Medicaid
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Compare Similar Plans in Polk County

Compare this plan with the two most-enrolled HMO D-SNP plans available in Polk County, Nebraska. Enrollment is based on CMS local enrollment data.

HMO D-SNP plan comparison for Polk County, Nebraska
Plan Detail Humana Gold Plus SNP-DE H0028-007 Humana Gold Plus SNP-DE H0028-080 Molina Medicare Complete Care
CMS Plan ID H0028-007-0 H0028-080-0 H6585-002-0
Local Enrollment 0 0 0
Monthly Premium $0.00 $0.00 $10.30
Medical Deductible $0.00 $0.00 $0.00
Maximum Out-of-Pocket $9,250.00 $9,250.00 $9,850.00
Part B Giveback Not offered Not offered Not offered
Primary Care $0 copay $0 copay $0 copay
Specialist 0% or 20% coinsurance $0 copay $0 copay
Part D Deductible $700.00 $0.00 $700.00
CMS Star Rating Not yet rated Not yet rated Not yet rated
Dental $0 copay $0 copay $0 copay
Vision $0 copay $0 copay $0 copay
Hearing $0 copay $0 copay $0 copay

Plan Benefits

Humana Gold Plus SNP-DE H0028-007 has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H0028-007.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H0028-007-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: 0% or 20% coinsurance

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Telehealth benefit
In-network: $0 or $0-$35 copay, 0% or 20% coinsurance
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
Not covered
Over-the-counter drug benefits
In-network: $0 copay
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $0 or $0-$345 copay, 0% or 20% coinsurance
Lab services
In-network: $0 copay
Outpatient x-rays
In-network: $0 copay, 0% or 20% coinsurance
Diagnostic tests and procedures
In-network: $0 copay, 0% or 20% coinsurance

Emergency and Urgent Care Services

Emergency room care
$0 or $115 copay
Worldwide emergency care
Coming soon
Urgent care
0% or 20% coinsurance
Inpatient hospital care
Tier 1
$0 or $1,950 per stay
Skilled Nursing Facility
Tier 1
$0 per day for days 1-20
$0 or $221 per day for days 21-100
Ground ambulance
In-network: $0 or $325 copay

Mental Health Services

Outpatient individual therapy
In-network: $0 or $35 copay
Outpatient group therapy
In-network: $0 or $35 copay
Inpatient psychiatric hospital care
Tier 1
$0 or $1,950 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: 0% or 20% coinsurance
Occupational therapy
In-network: 0% or 20% coinsurance

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay, 0% or 20% coinsurance
Durable medical equipment
In-network: 0% or 20% coinsurance
Prosthetics
In-network: 0% or 20% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0% or 0%-20% coinsurance
Other Part B drugs (Medicare-covered)
In-network: $0 copay, 0% or 0%-20% coinsurance

Dental Services

Oral exam
In-network: $0 copay
Dental x-rays
In-network: $0 copay
Cleaning
In-network: $0 copay
Periodontics
In-network: $0 copay
Endodontics
In-network: $0 copay
Restorative services
In-network: $0 copay
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: $0 copay

Vision Services

Routine eye exam
In-network: $0 copay
Contact lenses
In-network: $0 copay
Eyeglass frames only
Not covered
Eyeglass lenses only
Not covered
Eyeglasses (frames & lenses)
In-network: $0 copay
Upgrades
Not covered

Hearing Services

Hearing exam
In-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Prescription hearing aids
In-network: $0 copay
OTC hearing aids
In-network: $0 copay

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by Humana Gold Plus SNP-DE H0028-007 as a Part B benefit.

Prescription Drug Coverage

Humana Gold Plus SNP-DE H0028-007 includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

Humana Gold Plus SNP-DE H0028-007 (H0028-007-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($33.20)
Supplemental Part D Premium:$33.20
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$24.60
Low-Income Premium Subsidy Paid by CMS:$0.00
Low-Income Subsidy Premium:$0.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Humana starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Humana Gold Plus SNP-DE H0028-007 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Humana Gold Plus SNP-DE H0028-007 (H0028-007-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$0.00 copay
Generic$0.00 copay$0.00 copay
Preferred Brand17% coinsurance25% coinsurance
Non-Preferred Drug43% coinsurance25% coinsurance
Specialty Tier25% coinsurance25% coinsurance
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H0028)

Medicare evaluates plan quality using a star rating system developed by the Centers for Medicare & Medicaid Services (CMS). Ratings are based on measures such as health outcomes, member experience, and customer service, and are reported on a 1 to 5 star scale, with higher ratings indicating stronger overall performance.

2027 Medicare Star Ratings for Contract H0028
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Humana (official source) http://www.humana.com/medicare October 4, 2026
CMS.gov Dual Eligible Special Needs Plans (D-SNPs) April 28, 2026
Medicare.gov Compare types of Medicare Advantage Plans April 28, 2026
AARP.org The Big Choice: Original Medicare vs. Medicare Advantage April 28, 2026

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.