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Humana Gold Plus H1036-025 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-025 (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 H1036-025 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1036-025 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Tampa Bay. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1036-025 (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 H1036-025 (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 H1036-025 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $2400.00 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 H1036-025 (HMO) plan has an enhanced alternative drug benefit. This plan has no deductible. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For example, you will have no copay for preferred generic drugs at a standard pharmacy, but you will pay a $20 copay if you use standard mail.
Additional Benefits
The Humana Gold Plus H1036-025 (HMO) plan offers a range of benefits with varying costs. Hospital stays have a copay, starting at $75, with no copay after the 6th day. Outpatient services, primary care, preventive services, hearing, vision, dental, and home health services often have no copay or a low copay. This plan includes coverage for ambulance services, emergency services, and transportation, with specific copays and coinsurance depending on the service. The plan also covers partial hospitalization, dialysis, medical equipment, diagnostic services, cardiac rehabilitation, and skilled nursing facilities, with varying copays and coinsurance. Additionally, this plan covers acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $75 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $85, observation services have a $75 copay, ambulatory surgical center (ASC) services have no copay, individual and group sessions for outpatient substance abuse have a copay between $5 and $10, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1036-025 (HMO) plan, and requires prior authorization. You will pay a $10 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H1036-025 (HMO) plan, including ground and air ambulance services, as well as transportation services to a plan-approved health-related location. Ground ambulance services have a copay between $0 and $150, and air ambulance services have a 20% coinsurance. Transportation services have no copay, and the plan covers up to 50 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus H1036-025 (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Transportation have a $140 copay, while Urgently Needed Services have a $5 copay; all have no coinsurance.
Primary Care See details
The Humana Gold Plus H1036-025 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $5 copay, occupational therapy services with a copay between $5 and $15, and physician specialist services with a $10 copay. Mental health specialty services and psychiatric services have a $5 copay for individual and group sessions. Podiatry services and routine foot care have a $10 copay. Physical therapy and speech-language pathology services have a copay between $5 and $15. Additional telehealth benefits range from no copay to a $10 copay, and Opioid Treatment Program Services have a copay between $5 and $10.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services requiring prior authorization. This plan also covers glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. Some services, like health education, are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $10 copay, routine hearing exams with no copay for 1 exam every year, and fitting/evaluation for a hearing aid with no copay for 1 exam every year. Prescription Hearing Aids are partially covered, with no coverage for inner ear, outer ear, or over the ear hearing aids, but with a copay between $199 and $1299 for all other types, up to 2 hearing aids per year. OTC hearing aids are covered up to $125 every three months.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $10, and routine eye exams have no copay. Eyewear has no copay, and includes contact lenses and eyeglasses, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H1036-025 (HMO) plan covers dental services, including oral exams with no copay for up to 4 visits per year, dental x-rays with no copay for a limited number of x-rays, and cleanings with no copay for up to 2 visits per year. Other services like fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered; Prosthodontics (removable and fixed) has a 30% coinsurance.
Home Infusion bundled Services See details
The Humana Gold Plus H1036-025 (HMO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1036-025 (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Humana Gold Plus H1036-025 (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with a 20% coinsurance and no copay. Prosthetic devices and medical supplies have no coinsurance or copay, and diabetic equipment is covered with a 20% coinsurance for diabetic supplies, and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $25, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic radiological services have a copay up to $85 and therapeutic radiological services have a coinsurance up to 20% and a copay up to $5.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H1036-025 (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 covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H1036-025 (HMO) plan, with a $0 copay for days 1-20 and a $150 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H1036-025 (HMO) plan covers acupuncture with no copay, and over-the-counter items with a maximum benefit of $125 every three months. The plan also covers a meal benefit with no copay. However, other services like Early and Periodic Screening, Diagnostic, and Treatment services, and Private Duty Nursing Services are not covered.
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