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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 2025, 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 out of 5 stars in 2025.
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 $1.00. 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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy, but $10 copay if you use standard mail order. For preferred brand drugs, you will pay 35% coinsurance at a standard pharmacy, and 41% coinsurance through standard mail order. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H1036-062C (HMO) plan offers a range of benefits with varying costs. It includes no copay for many services like primary care, preventive services, and home health. You can expect copays for services like inpatient hospital stays, outpatient services, specialist visits, and dental, as well as coinsurance for ambulance, dialysis, and medical equipment. The plan also covers hearing, vision, and dental services with some no copay options. Additionally, it includes coverage for prescription hearing aids, over-the-counter items, and meal benefits. Some services require prior authorization, and certain services like private duty nursing are not covered.
Inpatient Hospital See details
The Humana Gold Plus H1036-062C (HMO) plan covers inpatient hospital stays, including acute and psychiatric care, with a $20 copay for days 1-6 and no copay for days 7-90. Additional days for inpatient hospital-acute have no copay, but non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $20 for outpatient hospital services, and a $20 copay for observation services. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay between $0 and $5 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by Humana Gold Plus H1036-062C (HMO), with a $5 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground ambulance services have a copay between $0 and $200, while air ambulance services have a 20% coinsurance. Transportation Services have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus H1036-062C (HMO) plan. Emergency Services has a $120 copay with no coinsurance, Urgently Needed Services has a $5 copay with no coinsurance, and Worldwide Emergency Services has a $120 copay with no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Gold Plus H1036-062C (HMO) plan covers primary care physician services with no copay, chiropractic services with a $5 copay, and occupational therapy services with no coinsurance and no copay. The plan also covers physician specialist services and mental health specialty services for a $5 copay, podiatry services for a $5 copay, other health care professional services with a $0-$5 copay, psychiatric services with a $5 copay, and physical therapy and speech-language pathology services with no copay. Additional telehealth benefits are covered with a $0-$5 copay, and opioid treatment program services are covered with a $0-$5 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services, an annual physical exam with no copay, and additional preventive services for which you may have a copay. This plan also covers kidney disease education services, and other preventive services including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $5 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, with a maximum plan benefit of $1250 per year, and OTC hearing aids are covered up to $75 every three months.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$5, and routine eye exams have no copay. Eyewear, which includes contact lenses and eyeglasses (lenses and frames) have no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $5 copay, and other dental services with no copay for 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. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit coverage of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H1036-062C (HMO) plan, including Medicare Part B insulin drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1036-062C (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with no coinsurance, and no copay for Prosthetic Devices, and Medical Supplies. Diabetic Equipment is covered, including Diabetic Supplies with 20% coinsurance and no copay and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $5, lab services have no copay, diagnostic radiological services have a copay up to $20, therapeutic radiological services have a copay up to $5, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-062C (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
For Humana Gold Plus H1036-062C (HMO), cardiac rehabilitation services are covered, but the plan does not cover any of the sub-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 H1036-062C (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $60 copay for days 21-100.
Other Services See details
Other Services includes acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year. Over-the-counter items are covered up to $75 every three months, and include nicotine replacement therapy and naloxone, but do not cover all drugs on the CMS OTC list. Meal benefits are covered with no copay, but require prior authorization. Services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), and Private Duty Nursing Services are not covered.
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