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Humana Gold Plus H1036-054C (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-054C (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 H1036-054C (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1036-054C (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Miami-Dade County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1036-054C (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 H1036-054C (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 H1036-054C (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $500.00 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 H1036-054C (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, standard generic drugs have no copay at a standard pharmacy, while preferred brand drugs have a $25 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your drug costs may be further reduced. Check the plan's formulary for specific drug coverage details.
Additional Benefits
The Humana Gold Plus H1036-054C (HMO) plan offers a wide range of benefits with a focus on low-cost care. Many services have no copay, including primary care, outpatient services, mental health, vision, and dental services. This plan covers inpatient hospital stays with no copay, and also includes coverage for ambulance services, with a $0-$75 copay for ground and 20% coinsurance for air. Other benefits include hearing aids, preventive services, and a $6,000 maximum benefit for dental.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Humana Gold Plus H1036-054C (HMO) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is no copay for a Medicare-covered stay. Non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute, are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $25, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with no copay, and Outpatient Blood Services with no copay. All services require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay. 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 of $0-$75, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay for up to 50 one-way trips per year, but 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 under the Humana Gold Plus H1036-054C (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $49 copay, while Urgently Needed Services have no copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $49 copay.
Primary Care See details
The Humana Gold Plus H1036-054C (HMO) plan offers primary care services with no copay, chiropractic services with no copay, occupational therapy services with no copay, physician specialist services with no copay, mental health specialty services with no copay, podiatry services with no copay, other health care professional services with no copay, psychiatric services with no copay, physical therapy and speech-language pathology services with no copay, additional telehealth benefits with no copay, and opioid treatment program services with no copay. However, routine chiropractic care is not covered.
Preventive Services See details
The Humana Gold Plus H1036-054C (HMO) plan covers preventive services, including an annual physical exam with no copay. Other services like wigs for hair loss, In-Home Support Services, Glaucoma Screening, and Diabetes Self-Management Training also have no copay. Some additional preventive services may require a copay, and services like Health Education, and Personal Emergency Response System (PERS) are not covered.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids (all types) are covered with a plan-specified amount of $1,000 per year, and OTC hearing aids are covered up to $75 every month. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision Services are covered under the Humana Gold Plus H1036-054C (HMO) plan. Eye exams and eyewear are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $6,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H1036-054C (HMO) plan, but require prior authorization and a doctor's referral. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with no coinsurance and a copay for Medicare-covered devices and supplies, and Diabetic Equipment with a 20% coinsurance for Diabetic Supplies and Medicare-covered shoes/inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered and require prior authorization and a doctor's referral. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a maximum copay of $25, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-054C (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 in practice. Prior authorization and a doctor referral are required, but all sub-services are listed as "not covered" by the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under this plan, but require prior authorization. There is no copay for days 1-20, and a $60 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 H1036-054C (HMO) plan covers acupuncture with no copay, and a limit of 25 treatments per year, as well as over-the-counter items with a maximum benefit of $75.00 per month. The plan also covers a meal benefit with no copay, and some services such as Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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