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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 2026, 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 4.5 out of 5 stars in 2026.
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. 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 $2700.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay for a one-month or three-month supply at standard pharmacies and through preferred mail-order services. Standard mail-order options for these lower tiers require a copayment of $10 to $20 for a one-month supply. Tier 3 preferred brand medications cost a $30 copay for a one-month supply at standard pharmacies and through preferred mail order. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply across all available pharmacy and mail-order channels.
Additional Benefits
The Humana Gold Plus H1036-044 (HMO) plan offers affordable medical coverage, featuring no copay for primary care visits, home health services, and urgent care. Specialists require a low $10 copay, while inpatient hospital stays cost a $170 daily copay for the first six days and no copay for days seven through 90. Outpatient hospital services range from no copay up to a $75 copay, with no coinsurance required for standard inpatient or outpatient care. For supplemental benefits, members enjoy no copay for routine vision exams and select eyewear up to a $350 annual limit, as well as routine hearing exams and up to $1,500 annually in preventive and restorative dental care. Diagnostic lab tests and x-rays also feature no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Additionally, the plan covers up to 50 one-way transportation trips per year and select over-the-counter items with no copay.
Inpatient Hospital See details
Humana Gold Plus H1036-044 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $170 copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H1036-044 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $75 copay for outpatient hospital services and a $170 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have a $10 to $35 copay.
Partial Hospitalization See details
Humana Gold Plus H1036-044 (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus H1036-044 (HMO), with ground ambulance services requiring a $0 to $240 copay and coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Humana Gold Plus H1036-044 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are provided with 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
Primary care services are covered by Humana Gold Plus H1036-044 (HMO) with no copay and no coinsurance for primary care physician visits, and a $10 copay and no coinsurance for specialists. Physical, occupational, and speech therapies require a $5 to $20 copay and no coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Humana Gold Plus H1036-044 (HMO) preventive services are partially covered with no copay and no coinsurance for covered options like annual physicals, kidney education, glaucoma screenings, diabetes self-management, in-home support, smoking cessation, and fitness benefits. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, disease management, telemonitoring, remote access technologies, home safety modifications, or counseling.
Hearing Services See details
Humana Gold Plus H1036-044 (HMO) hearing services include Medicare-covered exams for a $10 copay and no coinsurance, alongside routine exams, fittings, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199 to $1,299, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H1036-044 (HMO), offering one routine eye exam per year and select eyewear, including contact lenses and eyeglasses, with no copay, no coinsurance, and no deductible up to a $350 annual limit. Other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H1036-044 (HMO), which offers up to $1,500 annually with no copay and no coinsurance for preventive, diagnostic, and restorative care, though removable prosthodontics require a 30% coinsurance and no copay. Medicare-covered dental services have a $10 copay and no coinsurance, while fluoride treatments, endodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-044 (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance and no copay, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1036-044 (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required for these services.
Medical Equipment See details
Humana Gold Plus H1036-044 (HMO) covers medical equipment, including durable medical equipment (DME) and diabetic supplies which require a 20% coinsurance and no copay. Prosthetic devices are covered with a 20% coinsurance, while medical supplies and diabetic therapeutic shoes or inserts feature no copay, with prior authorization required across these benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-044 (HMO) covers diagnostic and radiological services with no coinsurance, though referrals and prior authorizations are required. Members pay no copay for lab and outpatient X-ray services, while diagnostic procedures carry a $0 to $75 copay, diagnostic radiology starts at a $0 copay, and therapeutic radiology starts at a $10 copay.
Home Health Services See details
Humana Gold Plus H1036-044 (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the Humana Gold Plus H1036-044 (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered. While the overall benefit features no coinsurance, these specific non-covered services carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-044 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $160 daily copay for days 21 to 100. Prior authorization is required, and while a 3-day prior hospital stay is not needed, additional days beyond the 100-day limit are not covered.
Other Services See details
Humana Gold Plus H1036-044 (HMO) partially covers other services with no copay and no coinsurance, including up to 25 acupuncture treatments per year, chronic illness meal benefits, and select over-the-counter items. Prior authorization is required for acupuncture and meals, while Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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