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Humana Gold Plus H1036-074 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-074 (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 H1036-074 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1036-074 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Citrus, Manatee, Sarasota. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1036-074 (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 H1036-074 (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 H1036-074 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $3550.00 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 H1036-074 (HMO) plan has an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at standard pharmacies, but have a $20 copay at standard mail pharmacies.
Additional Benefits
The Humana Gold Plus H1036-074 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, starting at $160, while outpatient services can have copays up to $175. Emergency services have a $140 copay, and primary care visits are covered with no copay. This plan also covers preventive services, including an annual physical exam with no copay. Hearing services include exams and hearing aids with copays, and vision services offer eye exams and eyewear with no copay. Dental services include Medicare dental services with a $20 copay, and many other dental services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For inpatient hospital acute stays, you will pay a $160 copay for days 1-6, and no copay for days 7-90, while additional days (91-999) have no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by this plan. Outpatient hospital services have a copay between $0 and $175, observation services have a $160 copay, and Ambulatory Surgical Center (ASC) services have no copay. Individual and group sessions for outpatient substance abuse have a copay between $10 and $60, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1036-074 (HMO) plan. You will have a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H1036-074 (HMO) plan. Ground ambulance services have a copay between $0-$215, while air ambulance services have a 20% coinsurance; transportation services to plan-approved health-related locations are covered with no copay for up to 50 one-way trips per year, but 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 by Humana Gold Plus H1036-074 (HMO). Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $5 copay; all have no coinsurance.
Primary Care See details
Humana Gold Plus H1036-074 (HMO) covers primary care physician services with no copay, chiropractic services with a $10 copay, occupational therapy with a $10-$25 copay, and physician specialist services with a $20 copay. The plan also covers mental health services with a $10 copay, podiatry services with a $20 copay, other health care professionals with a $0-$20 copay, psychiatric services with a $10 copay, physical therapy and speech-language pathology services with a $10-$25 copay, additional telehealth benefits with a $0-$20 copay, and opioid treatment program services with a $10-$60 copay.
Preventive Services See details
The Humana Gold Plus H1036-074 (HMO) plan covers preventive services including an annual physical exam with no copay. The plan also covers additional preventive services, Kidney Disease Education Services, and other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
The Humana Gold Plus H1036-074 (HMO) plan covers hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but specific types such as inner ear, outer ear, and over the ear are not covered; the plan covers prescription hearing aids (all types) with a copay between $199 and $1299. OTC hearing aids are also covered, with a maximum benefit of $100 every three months.
Vision Services See details
Humana Gold Plus H1036-074 (HMO) offers vision services including eye exams with a copay of $0-$20, and eyewear. Eyewear includes contact lenses and eyeglasses (lenses and frames) with no copay, and a combined maximum benefit of $300 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H1036-074 (HMO) plan covers Medicare Dental Services with a $20 copay. Other Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Prosthodontics, removable has a 30% coinsurance and no copay. 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 by the Humana Gold Plus H1036-074 (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with no coinsurance and no copay. Diabetic Equipment includes a 20% coinsurance and no copay for diabetic supplies, and no copay for diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, and Radiological Services. Diagnostic Procedures/Tests have a copay between $0 and $60, Lab Services have no copay, and Diagnostic Radiological Services have a copay up to $175. Therapeutic Radiological Services have a copay up to $10 and a coinsurance of at least 20%, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-074 (HMO) plan with no copay and no coinsurance; however, 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 the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation 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 H1036-074 (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $150 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H1036-074 (HMO) plan covers acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year. Over-the-counter items are covered with a maximum benefit of $100 every three months, and unused amounts carry forward, including nicotine replacement therapy and Naloxone. Meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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