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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 2026, 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 counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H1036-074 (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. Additionally, this plan comes with a Part B Premium reduction of $3.00. 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 $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) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, policyholders enjoy no copay when utilizing standard pharmacies or preferred mail order services. If you opt for standard mail order, generic drug copays range from $10 to $20 for a one-month supply. Tier 3 preferred brand drugs are available for a low $10 copay for a one-month supply at standard pharmacies and through preferred mail order. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 48% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance.
Additional Benefits
The Humana Gold Plus H1036-074 (HMO) plan offers robust medical coverage with no copay for primary care visits, preventive services, and urgent care. Specialist visits require a $20 copay, while inpatient hospital stays cost a $140 daily copay for the first six days and no copay for days seven through ninety. Emergency care is available with a $150 copay, which is waived if you are admitted to the hospital within twenty-four hours. For supplemental care, members enjoy dental and vision benefits with no copay or coinsurance for most routine services, subject to annual limits of $1,500 and $400 respectively. Routine hearing exams also feature no copay, while prescription hearing aids require copays ranging from $199 to $1,299. Other essential services like home health care, partial hospitalization, and diagnostic lab tests are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H1036-074 (HMO) covers inpatient hospital services with no coinsurance, requiring a $140 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H1036-074 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $175 copay for outpatient hospital services and a $140 copay per stay for observation services. Ambulatory surgical and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $10 to $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H1036-074 (HMO) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus H1036-074 (HMO) with prior authorization, featuring a $0 to $200 copay and no coinsurance for ground ambulance, and a 20% coinsurance with no copay for air ambulance. Transportation is partially covered with no copay or coinsurance for up to 50 one-way trips per year to plan-approved locations, while transportation to any other health-related location is not covered.
Emergency Services See details
Humana Gold Plus H1036-074 (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 covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-074 (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Additional covered services like physical therapy, mental health, and podiatry feature copays ranging from $0 to $35 and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H1036-074 (HMO) covers preventive services with no copays and no coinsurance, including annual physical exams, kidney education, glaucoma screenings, and diabetes training. This benefit is only partially covered because several additional services, such as health education, weight management programs, and medical nutrition therapy, are not covered.
Hearing Services See details
Humana Gold Plus H1036-074 (HMO) covers Medicare-covered hearing exams with a $20 copay and routine exams or fitting evaluations with no copay, all featuring no coinsurance. Prescription hearing aids are partially covered with copays from $199 to $1,299 and no coinsurance, excluding inner ear, outer ear, and over the ear models. OTC hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H1036-074 (HMO), offering no copay and no coinsurance for annual routine eye exams and select eyewear, which has a $400 annual limit. While one annual pair of contact lenses or complete eyeglasses is covered, other eye exam services, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-074 (HMO) partially covers dental services, featuring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most preventive and comprehensive services up to a $1,500 annual maximum. Removable prosthodontics require a 30% coinsurance with no copay, whereas fluoride, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-074 (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs require no copay and 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Plus H1036-074 (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required for these services.
Medical Equipment See details
Humana Gold Plus H1036-074 (HMO) covers durable medical equipment (DME) and diabetic supplies with a 20% coinsurance and no copay, subject to prior authorization. Prosthetics and medical supplies are covered with no copay and no coinsurance, while diabetic therapeutic shoes and inserts are offered with no copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-074 (HMO) covers diagnostic and radiological services, requiring prior authorizations and referrals for both. Diagnostic lab services, diagnostic radiology, and outpatient X-rays have no copay, while diagnostic procedures and tests have a copay ranging from $0 to $60 with no coinsurance, and therapeutic radiological services carry a 20% coinsurance with no copay.
Home Health Services See details
Humana Gold Plus H1036-074 (HMO) covers home health services with no copay and no coinsurance. Members must obtain a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Humana Gold Plus H1036-074 (HMO) with no copay and no coinsurance, though prior authorization and a referral are required. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Humana Gold Plus H1036-074 (HMO) with no coinsurance, requiring no copay for days 1 through 20 and a $160 daily copay for days 21 through 100. While prior authorization is required and a prior three-day hospital stay is not necessary, additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus H1036-074 (HMO) partially covers other services, offering acupuncture (up to 25 treatments per year), over-the-counter items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and the sub-services Other 1, Other 2, and Other 3 are not covered.
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