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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 2026, 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 4.5 out of 5 stars in 2026.
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 $4.00. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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:
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Drug Coverage
The Humana Gold Plus H1036-068 (HMO) prescription drug plan features an annual deductible of $615. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, there is no copay for 1-month or 3-month supplies filled at standard pharmacies or via preferred mail order. If you use standard mail order, Tier 1 drugs require a $10 copay for a 1-month supply, and Tier 2 drugs require a $20 copay. For Tier 3 (Preferred Brand) drugs, you will pay a $30 copay for a 1-month supply at standard pharmacies and preferred mail order, or $47 through standard mail order. Tier 4 (Non-Preferred) drugs carry a 50% coinsurance, and Tier 5 (Specialty) medications require a 25% coinsurance for a 1-month supply across all fulfillment options. Understanding these copayments and coinsurance rates can help you maximize your savings on the Humana Gold Plus H1036-068 (HMO) plan.
Additional Benefits
The Humana Gold Plus H1036-068 (HMO) plan offers comprehensive healthcare coverage featuring no copay for primary care doctor visits and a low $10 copay for specialists. For hospital stays, members pay a $125 daily copay for the first five days of inpatient care, while outpatient surgical center visits and urgent care services require no copay. Emergency room visits carry a $150 copay, which is waived if you are admitted to the hospital within 24 hours. This Medicare Advantage plan also provides valuable supplemental benefits, including preventive dental, annual routine vision exams, and OTC hearing aids all with no copay. Dental services are covered up to a $1,750 annual limit, and members receive up to $300 annually for covered eyewear. Other essential services like home health care, diagnostic lab tests, and up to 50 one-way transportation trips per year are also available with no copay.
Inpatient Hospital See details
Humana Gold Plus H1036-068 (HMO) covers inpatient hospital services with no coinsurance, featuring a $125 daily copay for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Humana Gold Plus H1036-068 (HMO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital visits require a copay of $0 to $125 ($125 per stay for observation services), and outpatient substance abuse sessions have a $10 to $35 copay, with prior authorization and referrals required for most services.
Partial Hospitalization See details
Humana Gold Plus H1036-068 (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 H1036-068 (HMO) covers ambulance services with a copay of $0 to $240 and coinsurance for ground transport, and a 20% coinsurance and copay for air transport. Transportation services are partially covered, providing up to 50 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H1036-068 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are available with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-068 (HMO) primary care benefits feature primary care physician visits with no copay and no coinsurance, and specialist visits for a $10 copay and no coinsurance. Other services like physical therapy, mental health, and telehealth range from a $0 to $35 copay with no coinsurance, while some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Humana Gold Plus H1036-068 (HMO) preventive services are partially covered with no copay and no coinsurance for covered care, which includes annual physical exams, kidney disease education, and select supplemental benefits like in-home support and memory fitness. However, several supplemental benefits are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Humana Gold Plus H1036-068 (HMO) covers hearing services, offering Medicare-covered exams for a $10 copay and no coinsurance, alongside annual routine exams, fitting evaluations, and unlimited OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199 to $1,299 for up to two devices per year, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H1036-068 (HMO) with no deductibles and no coinsurance, featuring no copay for an annual routine eye exam and a $0 to $10 copay for other covered exams. Covered eyewear, including contact lenses and complete eyeglasses (lenses and frames), has no copay up to a $300 annual limit, while standalone eyeglass lenses, standalone frames, upgrades, and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H1036-068 (HMO) up to a $1,750 annual limit, offering no copay and no coinsurance for most preventive, diagnostic, and restorative care, while removable prosthodontics require a 30% coinsurance (no copay) and Medicare-covered dental has a $10 copay (no coinsurance). Fluoride treatment, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-068 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Medicare Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H1036-068 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Medical Equipment See details
Humana Gold Plus H1036-068 (HMO) covers durable medical equipment (DME) and diabetic supplies with a 20% coinsurance and no copay, while medical supplies and diabetic therapeutic shoes are covered with no copay. Prosthetic devices are covered with a 20% coinsurance, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H1036-068 (HMO) with no coinsurance, though prior authorization and referrals are required. Lab and outpatient X-ray services have no copay, while diagnostic procedures and tests carry a copay ranging from $0 to $90, and therapeutic radiological services require a minimum copay of $10.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H1036-068 (HMO) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-068 (HMO) covers cardiac rehabilitation services with no coinsurance and a $10 copay per session. This coverage includes intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services, though prior authorization and referrals are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H1036-068 (HMO) with no coinsurance and no copay for days 1 through 20, followed by a $160 daily copay for days 21 through 100. Prior authorization is required for these services, and additional days beyond the 100-day Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1036-068 (HMO) offers coverage for acupuncture, over-the-counter (OTC) items, and meal benefits with no copays and no coinsurance. Acupuncture is limited to 25 treatments per year, and both acupuncture and meal benefits require prior authorization.
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