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Humana Gold Plus H1036-044 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-044 (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 H1036-044 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1036-044 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Flagler and Volusia counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1036-044 (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 H1036-044 (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 H1036-044 (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 $3200.00 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 H1036-044 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, but $20.00 at a standard mail pharmacy. For non-preferred drugs, you will pay 33% coinsurance.
Additional Benefits
The Humana Gold Plus H1036-044 (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient services, with varying copays, as well as emergency, primary care, and preventive services with no or low copays. Additional benefits include coverage for hearing, vision, and dental services, with copays for some services, alongside medical equipment, diagnostic, and home health services. The plan also covers specific services like acupuncture, over-the-counter items, and a meal benefit for chronic illness, offering a well-rounded approach to healthcare.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-6, there is a $175 copay, and for days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, 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, with a copay between $0 and $75, and observation services with a $175 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay between $10 and $50 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1036-044 (HMO) plan with a $25 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a copay between $0 and $210, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 50 one-way trips per year, and transportation includes taxi, bus/subway, and medical transport. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus H1036-044 (HMO) plan. Emergency Services has a $140 copay, and Urgently Needed Services has a $5 copay, while Worldwide Emergency Services has a $140 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Gold Plus H1036-044 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $10 copay, and occupational therapy services with a copay between $5 and $20. The plan also covers physician specialist services with a $10 copay, and mental health specialty services, podiatry services, psychiatric services, and opioid treatment program services with a copay of $10. Physical therapy and speech-language pathology services have a copay between $5 and $20, and additional telehealth benefits have a copay between $0 and $10.
Preventive Services See details
Preventive Services include annual physical exams with no copay, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit, all with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing exams have a $10 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, with a copay between $199 and $1299 for all types of prescription hearing aids. OTC hearing aids are covered up to $100 every three months.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0-$10 and eyewear with no copay. Eyeglasses (lenses and frames) and contact lenses are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H1036-044 (HMO) plan covers Medicare Dental Services with a $10 copay. Other Dental Services include oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, periodontics, prosthodontics (removable), and oral and maxillofacial surgery with no copay. Fluoride treatment, endodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Humana Gold Plus H1036-044 (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0-20%. Other services have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with no copay. Diabetic Equipment is covered with a 20% coinsurance and a $10 copay for Diabetic Therapeutic Shoes/Inserts, and no copay and 20% coinsurance for Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $75, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $50, Therapeutic Radiological Services with a copay between $10 and $50, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-044 (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 the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and 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 H1036-044 (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $150 copay for days 21-100.
Other Services See details
The Humana Gold Plus H1036-044 (HMO) plan covers acupuncture with no copay, up to 25 treatments per year, and also covers over-the-counter items, including nicotine replacement therapy and Naloxone, with a maximum benefit of $100 every three months. The plan also covers a meal benefit with no copay for a chronic illness, but many other services are not covered.
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