A non-government entity
Humana Gold Plus H1036-068 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-068 (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 H1036-068 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1036-068 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Jacksonville Metro area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1036-068 (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 H1036-068 (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 H1036-068 (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 $3300.00 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:
Sign up for Humana Gold Plus H1036-068 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H1036-068 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, and a $20 copay at a standard mail pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Humana Gold Plus H1036-068 (HMO) plan offers a wide range of benefits. You'll have a $125 copay for inpatient hospital stays (days 1-5), and no copay for days 6-90. Outpatient services have varying copays, and many services, like primary care, preventive services, dental exams, and home health services, are covered with no copay. This plan also covers ambulance services, with a copay up to $245 for ground transport and 20% coinsurance for air ambulance. You'll have a $140 copay for emergency services, and many other services like hearing and vision exams have low copays. The plan also has a $1,500 maximum benefit per year for dental services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you pay a $125 copay for days 1-5, and no copay for days 6-90; additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by Humana Gold Plus H1036-068 (HMO). Outpatient Hospital Services have a copay between $0 and $125, Observation Services have a $125 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $10 and $90, while Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1036-068 (HMO) plan, with a $20 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a copay of $0 - $245, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay, and are limited to 50 one-way trips per year. 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. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Transportation each have a $140 copay, while Urgently Needed Services has a $5 copay.
Primary Care See details
The Humana Gold Plus H1036-068 (HMO) plan covers primary care services with no copay, chiropractic services with a $10 copay, and occupational therapy services with a copay between $5 and $20. Physician specialist services have a $10 copay, while mental health and psychiatric services have a copay of $10. Podiatry services have a $10 copay, other health care professionals have a copay between $0 and $10, and physical therapy and speech-language pathology services have a copay between $5 and $20. The plan also covers additional telehealth benefits with a copay between $0 and $10, and opioid treatment program services with a copay between $10 and $90.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and additional preventive services, kidney disease education services, and other preventive services. Additional preventive services, which require prior authorization, may have a copay, as do Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. In-home support services, additional sessions of smoking and tobacco cessation counseling, and fitness benefits are also covered.
Hearing Services See details
The Humana Gold Plus H1036-068 (HMO) plan covers hearing exams with a $10 copay and routine hearing exams and fitting/evaluation for hearing aids with no copay; prescription hearing aids are covered with a copay between $199 and $1299, and OTC hearing aids are covered up to $45 per month. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Humana Gold Plus H1036-068 (HMO) plan covers vision services including eye exams with a copay of $0-$10 and eyewear with a combined maximum of $300 per year, with no copay for contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H1036-068 (HMO) plan covers dental services, including oral exams and dental x-rays with no copay, and other diagnostic and preventive services with a $0 copay. Prosthodontics, removable services have a 30% coinsurance, and the plan has a $1,500 maximum benefit per year. Fluoride treatment, endodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H1036-068 (HMO) plan, requiring prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and no copay. Medical Supplies have no copay, and Prosthetic Devices have a 20% coinsurance. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $90, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $125, Therapeutic Radiological Services with a copay between $10 and $50, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-068 (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 the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. A doctor referral and prior authorization are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H1036-068 (HMO) plan with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $150 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H1036-068 (HMO) plan covers acupuncture with no copay, up to 25 treatments per year, and requires prior authorization. Over-the-counter items are covered with a maximum benefit of $45.00 per month, and meal benefits are covered with no copay and require prior authorization. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved