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Humana Gold Plus H1036-137 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-137 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H1036-137 (HMO-POS) in 2025, please refer to our full plan details page.
Humana Gold Plus H1036-137 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Charlotte 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 H1036-137 (HMO-POS) 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 H1036-137 (HMO-POS).
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 H1036-137 (HMO-POS), 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 $2.00. 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 $350.00 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 $9350.00 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 H1036-137 (HMO-POS) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your medications depending on the drug tier and the pharmacy you use. For example, you'll pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy, while standard generic drugs have a $47 copay. Once your total 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 H1036-137 (HMO-POS) plan offers a wide range of benefits, including coverage for inpatient and outpatient services with varying copays, as well as emergency services with a $110 copay. Preventative services such as an annual physical exam are covered with no copay. You can also expect coverage for hearing and vision services, with hearing exams costing $25, and routine eye exams and eyewear having no copay. This plan includes dental services with a $1,500 annual maximum, and medical equipment with 20% coinsurance. Other benefits include home health services with no copay, and skilled nursing facility coverage with no copay for the first 20 days. The plan also includes acupuncture, over-the-counter items with a quarterly benefit, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $460 copay for days 1-5, and no copay for days 6-90, with additional days 91-999 having no copay. Inpatient Hospital Psychiatric has a $460 copay for days 1-4, and no copay for days 5-90. Non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $450, observation services with a $460 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with copays between $45 and $100 for individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1036-137 (HMO-POS) plan, with an $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance Services are covered, with a $315 copay for both Ground and Air Ambulance Services, and no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Humana Gold Plus H1036-137 (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services have a $45 copay. There is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus H1036-137 (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. Physician specialist services have a $25 copay, while mental health specialty services and psychiatric services have a $45 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits range from no copay to a $45 copay. Opioid treatment program services have a copay between $45 and $100.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional preventive services, including Fitness Benefit, are covered with a copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 per hearing aid. OTC hearing aids are covered up to $50 every three months.
Vision Services See details
The Humana Gold Plus H1036-137 (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses (lenses and frames), has no copay, with a combined maximum benefit of $350 per year. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $1,500 per year. Medicare Dental Services require a $25 copay, while other dental services such as oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H1036-137 (HMO-POS) plan. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and authorization required, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 10-20% 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 under the Humana Gold Plus H1036-137 (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $120, Lab Services have no copay, Diagnostic Radiological Services have a maximum copay of $325, and Therapeutic Radiological Services have a copay of at least $25 and a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-137 (HMO-POS) 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 the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H1036-137 (HMO-POS), but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Gold Plus H1036-137 (HMO-POS) plan covers acupuncture with a $25 copay and a limit of 20 treatments per year, over-the-counter items with a $50 maximum benefit every three months, and a meal benefit with no copay. The plan does not cover 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.
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