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Humana Gold Plus H1036-065C (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-065C (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 H1036-065C (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-065C (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Broward 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 H1036-065C (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 H1036-065C (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 H1036-065C (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 $1000.00 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 H1036-065C (HMO) Medicare Advantage plan offers a $0 drug deductible, allowing your prescription drug coverage to start immediately. For Tier 1 preferred generics and Tier 2 generics, there is no copay for a 1-month or 3-month supply filled at standard pharmacies or through preferred mail order. If you utilize standard mail order for these generic tiers, copays range from $5 to $10 for a 1-month supply. For Tier 3 preferred brand drugs, you will pay a low $5 copay for a 1-month supply at standard pharmacies or through preferred mail order, compared to a $47 copay for standard mail order. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 49% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance. This plan structure provides cost-effective options for common prescriptions, particularly when using preferred mail order services.
Additional Benefits
The Humana Gold Plus H1036-065C (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, specialist appointments, and inpatient hospital stays. Outpatient hospital services feature no coinsurance and a copay of up to $60, while emergency room visits require a $115 copay that is waived upon admission. Additionally, preventive care, diagnostic services, and home health care are fully covered with no copay or coinsurance. Supplemental benefits include dental coverage with no copay up to a $5,000 annual limit and a $400 yearly allowance for eyeglasses and contacts. Members also benefit from routine hearing exams, hearing aid coverage of up to $750 per ear every two years, and up to 50 one-way transportation trips per year with no copay. Skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $60 daily copay for days 21 through 100.
Inpatient Hospital See details
Humana Gold Plus H1036-065C (HMO) inpatient hospital benefits are partially covered with no copay and no coinsurance for Medicare-covered acute and psychiatric stays, though prior authorization is required. Non-Medicare-covered stays, hospital upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Humana Gold Plus H1036-065C (HMO) covers outpatient services with no coinsurance, featuring a copay of $0 to $60 for outpatient hospital services. There is no copay or coinsurance for ambulatory surgical center services, observation services, outpatient substance abuse sessions, or blood services, though prior authorization and referrals are required.
Partial Hospitalization See details
Humana Gold Plus H1036-065C (HMO) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-065C (HMO) covers ground ambulance services with a copay of $0 to $75 and coinsurance, and air ambulance services with a 20% coinsurance and a 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, while transportation to any other health-related location is not covered.
Emergency Services See details
Humana Gold Plus H1036-065C (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care, specialist visits, therapies, and mental health services under the Humana Gold Plus H1036-065C (HMO) are covered with no copay and no coinsurance. While some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by Humana Gold Plus H1036-065C (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and select screenings. However, this benefit is only partially covered, as it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety devices, and counseling services.
Hearing Services See details
Humana Gold Plus H1036-065C (HMO) offers hearing services with no copay and no coinsurance for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $750 maximum per ear every two years, but inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Humana Gold Plus H1036-065C (HMO) offers partially covered vision services with no copay, no coinsurance, and no deductible for one routine eye exam annually and up to $400 per year for contact lenses and eyeglasses (lenses and frames). Other eye exam services, standalone eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Humana Gold Plus H1036-065C (HMO) plan with no copay and no coinsurance for covered treatments, up to a $5,000 yearly maximum. While preventive and restorative services are included, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-065C (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have a coinsurance of no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H1036-065C (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required for this benefit.
Medical Equipment See details
Humana Gold Plus H1036-065C (HMO) covers medical equipment with no copay, though prior authorization is required for these services. Durable medical equipment and diabetic equipment are subject to a 20% coinsurance and no copay, while prosthetic devices and medical supplies are covered with no coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H1036-065C (HMO) with no copay and no coinsurance. These covered services, including lab work, outpatient X-rays, and therapeutic radiological services, require prior authorization and referrals.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H1036-065C (HMO) with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-065C (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-065C (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $60 daily copay for days 21 to 100. Prior authorization is required, a prior 3-day hospital stay is not required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Humana Gold Plus H1036-065C (HMO) covers additional services including acupuncture up to 25 treatments per year, chronic illness meal benefits, and select over-the-counter (OTC) items with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and OTC items are available via reimbursement.
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