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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 2026, 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 Hernando, Hillsborough, Pasco, Pinellas counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $3.00. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2000.00 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) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. Standard mail order costs for these tiers range from a $10 to $20 copay for a one-month supply. Tier 3 preferred brand drugs require a low $5 copay for a one-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The Humana Gold Plus H1036-025 (HMO) plan offers comprehensive medical coverage featuring no copays for primary care physician visits, routine preventive services, and home health care. Specialist visits require a low $10 copay, while inpatient hospital stays cost a $50 daily copay for the first six days and no copay for subsequent days. Emergency room visits carry a $150 copay, which is waived if you are admitted, and urgent care services are available with no copay. This plan also includes valuable supplemental benefits, such as routine dental and vision care with no copays up to annual limits of $3,000 and $300, respectively. Routine hearing exams and over-the-counter hearing aids feature no copays, while up to 50 one-way transportation trips per year to plan-approved locations are fully covered. For other medical needs, durable medical equipment and dialysis require a 20% coinsurance, while skilled nursing facility stays have no copay for the first 20 days.
Inpatient Hospital See details
Humana Gold Plus H1036-025 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $50 daily copay for days 1 to 6 and no copay for days 7 and beyond. While acute care includes unlimited additional days with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H1036-025 (HMO) covers outpatient services with no coinsurance, featuring a copay of up to $85 for outpatient hospital services and a $50 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copays, while outpatient substance abuse sessions range from no copay to a $5 copay, with prior authorization and referrals required for most of these services.
Partial Hospitalization See details
Humana Gold Plus H1036-025 (HMO) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-025 (HMO) covers ground ambulance services with a copay of up to $150 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Additionally, up to 50 one-way trips per year to plan-approved locations are covered with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H1036-025 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services have no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-025 (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $10 copay and no coinsurance. Other covered benefits, all featuring no coinsurance, include physical and occupational therapy with a $5 to $15 copay, mental health services with a $5 copay, and telehealth with a $0 to $10 copay, though chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H1036-025 (HMO) covers preventive services, including annual physical exams, kidney disease education, and diabetes training, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering fitness and in-home support with no copay or coinsurance, but excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home/bathroom safety, and counseling.
Hearing Services See details
Humana Gold Plus H1036-025 (HMO) covers hearing services, offering routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $10 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $199 to $1,299 and no coinsurance, excluding inner ear, outer ear, and over-the-ear models, while over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H1036-025 (HMO) provides partially covered vision services with no copay and no coinsurance for routine eye exams and eyewear, including contact lenses and eyeglasses (lenses and frames) up to a $300 annual limit. Prior authorization and referrals are required, and coverage excludes other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades.
Dental Services See details
Humana Gold Plus H1036-025 (HMO) partially covers dental services up to a $3,000 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive care, while prosthodontics require a 30% coinsurance and no copay. Medicare-covered dental has a $10 copay and no coinsurance, but fluoride treatments, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-025 (HMO) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H1036-025 (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this covered care.
Medical Equipment See details
Humana Gold Plus H1036-025 (HMO) covers durable medical equipment and diabetic supplies with a 20% coinsurance and no copay, while prosthetics, medical supplies, and diabetic therapeutic shoes or inserts have no copay. Prior authorization is required for these services, prosthetics and medical supplies carry no coinsurance, and diabetic supplies are limited to select manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-025 (HMO) covers diagnostic and radiological services, offering lab services, diagnostic radiology, and outpatient X-rays with no copays or coinsurance. Diagnostic procedures and tests feature a $0 to $25 copay and no coinsurance, while therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H1036-025 (HMO) with no copay and no coinsurance. Members must obtain a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus H1036-025 (HMO) plan, as none of the individual sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered in practice.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-025 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $160 copay for days 21 to 100. Prior authorization is required and a prior three-day hospital stay is not needed, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Humana Gold Plus H1036-025 (HMO) covers select other services with no copay and no coinsurance, including over-the-counter (OTC) items, chronic illness meals, and up to 25 acupuncture treatments per year. Prior authorization is required for acupuncture and meal benefits, and other unspecified services are not covered.
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