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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 2026, 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 4.5 out of 5 stars in 2026.
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 $2.00. 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) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics, Tier 2 generics, and Tier 3 preferred brands, there is no copay for one-month or three-month supplies at standard pharmacies and through preferred mail order. If you choose standard mail order, Tier 2 generics carry a $4 copay for a one-month supply ($12 for three months), and Tier 3 preferred brands require a $5 copay for one month ($15 for three months). Tier 4 non-preferred drugs require a $50 copay for a one-month supply at standard pharmacies and mail order, while a three-month supply costs $150, or a slightly lower $140 through preferred mail order. For Tier 5 specialty drugs, you will pay a 33% coinsurance for a one-month supply at standard pharmacies, preferred mail order, and standard mail order. This straightforward pricing structure helps Humana Gold Plus H1036-054C (HMO) members easily manage their healthcare budget and prescription medication expenses.
Additional Benefits
The Humana Gold Plus H1036-054C (HMO) plan offers comprehensive medical coverage with no copays and no coinsurance for many essential services, including inpatient hospital stays, primary and specialist doctor visits, and preventive care. Outpatient services, diagnostic labs, and home health care are also covered with no coinsurance and generally feature no copays. For emergency care, members pay a $75 copay which is waived if admitted, while urgent care services require no copay. This plan also includes valuable supplemental benefits like dental coverage up to a $6,000 annual limit and vision services up to $450 annually, both with no copays or coinsurance. Routine hearing exams and over-the-counter hearing aids are covered with no copay, while dialysis and durable medical equipment require a 20% coinsurance. Additionally, members can access up to 50 free one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Humana Gold Plus H1036-054C (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under the Humana Gold Plus H1036-054C (HMO) with no coinsurance, featuring no copays for ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Outpatient hospital services require no coinsurance with a copay ranging from $0 to $50, while outpatient observation services have no copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H1036-054C (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 H1036-054C (HMO) covers ground ambulance services with a $0 to $75 copay and coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 50 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H1036-054C (HMO) covers emergency services with a $75 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $75 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-054C (HMO) covers primary care, specialist visits, mental health, therapy, podiatry, and telehealth services with no copay and no coinsurance. Although chiropractic services are technically listed as covered, routine and other chiropractic sub-services are not covered in practice.
Preventive Services See details
Humana Gold Plus H1036-054C (HMO) preventive services are covered with no copay and no coinsurance for annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive benefits are partially covered with no copay and no coinsurance, including memory fitness, chemotherapy wigs, and in-home support, while services like health education, weight management, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered under Humana Gold Plus H1036-054C (HMO) with no copay and no coinsurance for exams, OTC hearing aids, and prescription hearing aids. While exams and OTC hearing aids are fully covered, prescription hearing aids are partially covered up to a $1,000 annual limit per ear, with inner ear, outer ear, and over the ear prescription hearing aids not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H1036-054C (HMO) with no copay, no coinsurance, and no deductible for covered services. Routine eye exams (one per year) and eyewear, including contact lenses and eyeglasses (lenses and frames), are covered up to a $450 annual limit, while other eye exams, standalone eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-054C (HMO) offers partially covered dental services with no copay and no coinsurance for covered benefits, up to a maximum annual limit of $6,000. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus H1036-054C (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and insulin, require a coinsurance ranging from no coinsurance to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H1036-054C (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H1036-054C (HMO), featuring a 20% coinsurance and no copay for durable medical equipment and diabetic supplies. Prosthetic devices and medical supplies are covered with no copay and no coinsurance, while diabetic therapeutic shoes and inserts have no copay, with prior authorization required for most items.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-054C (HMO) covers diagnostic and radiological services with no coinsurance and no copays for lab services, diagnostic procedures, and outpatient X-rays. Diagnostic and therapeutic radiological services require a minimum copay of $0, and all services require prior authorization and referrals.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H1036-054C (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-054C (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though referrals and prior authorization are required. While some services are covered, specific sub-services including standard cardiac, intensive cardiac, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus H1036-054C (HMO) with no coinsurance and requires prior authorization, though a prior three-day hospital stay is not required. There is no copay for days 1 through 20 and a $60 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1036-054C (HMO) covers other services with no copay and no coinsurance, including up to 25 acupuncture treatments per year, over-the-counter item reimbursements, and meals for chronic illnesses. Prior authorization is required for acupuncture and meals, and certain over-the-counter drugs are not covered under this plan.
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