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Humana Gold Plus H1036-062C (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-062C (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 H1036-062C (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-062C (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Palm Beach 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 H1036-062C (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 H1036-062C (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 H1036-062C (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 $1625.00 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 H1036-062C (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics, you will pay no copay for 1-month and 3-month supplies at standard pharmacies, preferred mail order, and standard mail order. Tier 2 generic drugs also have no copay through standard pharmacies and preferred mail order, though standard mail order costs range from a $10 copay for a 1-month supply to a $30 copay for a 3-month supply. Tier 3 preferred brand drugs require a $15 copay for a 1-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. Tier 4 non-preferred drugs carry a 47% coinsurance across standard pharmacies, preferred mail order, and standard mail order. Finally, Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply across all fulfillment options.
Additional Benefits
The Humana Gold Plus H1036-062C (HMO) plan offers robust medical coverage with minimal out-of-pocket costs, featuring no copays for primary care visits, preventive services, and home health care. Specialist visits, mental health services, and diagnostic tests are highly affordable, requiring only a $5 copay or less, while inpatient hospital stays have a low $20 daily copay for the first six days and no copay thereafter. Emergency room care is covered with a $130 copay, which is waived upon hospital admission, while urgent care visits require no copay. This plan also includes comprehensive dental, vision, and hearing benefits with no coinsurance and mostly no copays, including up to $3,000 annually for dental care and $1,250 per ear for prescription hearing aids. Additionally, members benefit from no copays on routine eye exams, up to 50 free one-way transportation trips, and acupuncture treatments. Durable medical equipment and dialysis services are covered with a standard 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H1036-062C (HMO) covers inpatient hospital services with no coinsurance, requiring a $20 copay per day for days 1 through 6 and no copay for days 7 through 90 for both acute and psychiatric stays. Prior authorization is required, and while unlimited additional acute days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H1036-062C (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which have no copay. Outpatient hospital services have a copay of $0 to $20 ($20 for observation services), and outpatient substance abuse sessions have a copay of $0 to $5.
Partial Hospitalization See details
Humana Gold Plus H1036-062C (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-062C (HMO) covers ground ambulance services with a copay of $0 to $200 and air ambulance services with a 20% coinsurance. Transportation services are partially covered, providing up to 50 one-way trips per year to plan-approved locations with no copay and no coinsurance, while trips to any other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H1036-062C (HMO) covers emergency services with a $130 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 each require a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-062C (HMO) offers primary care, occupational therapy, physical therapy, and speech-language pathology services with no copay and no coinsurance, while chiropractic services are not covered. Specialist, mental health, psychiatric, and podiatry services require a $5 copay and no coinsurance, with telehealth, opioid treatment, and other professional services ranging from no copay to a $5 copay and no coinsurance.
Preventive Services See details
Preventive Services under the Humana Gold Plus H1036-062C (HMO) plan are partially covered with no copay and no coinsurance, though prior authorization is required for some services. Covered benefits include annual physical exams, fitness benefits, and in-home support, while sub-services such as health education, nutritional therapy, and personal emergency response systems are not covered.
Hearing Services See details
Humana Gold Plus H1036-062C (HMO) hearing services are covered, featuring a $5 copay and no coinsurance for Medicare-covered exams, and routine exams and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered up to $1,250 per ear annually with no copay or coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Gold Plus H1036-062C (HMO) partially covers vision services with no deductibles, no coinsurance, and copays ranging from $0 to $5. Routine eye exams and eyewear, including contact lenses and eyeglasses (lenses and frames) up to a $300 annual limit, are covered with no copay, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services under the Humana Gold Plus H1036-062C (HMO) are partially covered up to a $3,000 annual maximum, featuring no copay and no coinsurance for most preventive and comprehensive dental care, while Medicare-covered dental services require a $5 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-062C (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H1036-062C (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Humana Gold Plus H1036-062C (HMO) covers durable medical equipment and diabetic supplies with a 20% coinsurance and no copay, while prosthetics and medical supplies are available with no copay and no coinsurance. Diabetic therapeutic shoes and inserts are also covered with no copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-062C (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests carry a copay of $0 to $5, and diagnostic and therapeutic radiological services have copayments starting at $0.
Home Health Services See details
Humana Gold Plus H1036-062C (HMO) covers Home Health Services with no copay and no coinsurance. Both a referral and prior authorization are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H1036-062C (HMO) with no copayment and no coinsurance, although referrals and prior authorization are required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-062C (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Patients pay no copay for days 1 through 20 and a $60 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1036-062C (HMO) partially covers other services, providing acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance, though other miscellaneous benefits are not covered. Prior authorization is required for the meal benefit and acupuncture, which is limited to 25 treatments annually.
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