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Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Broward, Miami-Dade, and Palm Beach counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP).
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 SNP-DE H1036-077A (HMO D-SNP), 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 a $500.00 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 $3400.00 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 SNP-DE H1036-077A (HMO D-SNP) plan has a $500 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For Tier 1 preferred generic drugs, you will have no copay at standard and preferred mail pharmacies, and a $20 copay at standard mail pharmacies. Tier 2 standard generic drugs have a $47 copay. Tier 3 preferred brand and Tier 4 non-preferred drugs have a 25% coinsurance. Once your total yearly drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) plan offers a wide range of benefits with no copay, including inpatient and outpatient hospital services, primary care, preventive services, and home health services. Additionally, the plan covers dental, vision, and hearing services, with a $5,000 annual maximum for dental and a $1,000 annual maximum for hearing aids. This plan also provides coverage for ambulance, emergency, and transportation services with no copay, as well as medical equipment, diagnostic services, and dialysis services. Other notable benefits include coverage for acupuncture, OTC items up to $1500 per year, and meal benefits for chronic illnesses, all with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center Services, and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have no copay for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered with a $0 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have no copay, while air ambulance services have a 20% coinsurance, and transportation services have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP), with no copay or coinsurance for Emergency Services, and no coinsurance and a $0 copay for Urgently Needed Services. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay or coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Mental health specialty services, other health care professional services, psychiatric services, and opioid treatment program services have a $0 minimum and maximum copay. Occupational therapy services have a copay, but the exact amount is not specified. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for a yearly physical exam with no copay, and other preventive services, including glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay. Additional services like wigs for hair loss related to chemotherapy, in-home support services, additional sessions of smoking and tobacco cessation counseling, and fitness benefits are also covered with no copay. Other services such as health education, in-home safety assessment, personal emergency response systems, and several others are not covered.
Hearing Services See details
Hearing exams and fitting/evaluation for hearing aids are covered with no copay, while prescription hearing aids are covered with a maximum benefit of $1000 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered, and there is a combined maximum of $400 per year for eyewear.
Dental Services See details
Dental services are covered, with a $5,000 maximum benefit per year. Medicare dental services, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered with no copay. Fluoride treatment and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. There is no copay for Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, or Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. There is no copay for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics, and Diabetic Equipment. DME and Prosthetic Devices have no copay and no coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay and no coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests and Therapeutic Radiological Services have no copay, while Lab Services and Outpatient X-Ray Services also have no copay.
Home Health Services See details
Home Health Services are covered 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 specific services including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered by this Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) plan. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
The Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) plan covers acupuncture with no copay, up to 25 treatments per year, and also covers over-the-counter (OTC) items up to $1500 per year, including nicotine replacement therapy and naloxone. The plan also covers meal benefits with no copay for a chronic illness. However, 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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