A non-government entity
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 2026, 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 4.5 out of 5 stars in 2026.
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 $1.00. 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 $9250.00 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:
Sign up for Humana Gold Plus H1036-137 (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H1036-137 (HMO-POS) Medicare Advantage plan features an annual prescription drug deductible of $350. For Tier 1 preferred generic drugs, you will pay no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications cost a $5 copay for a one-month supply, with no copay required for a three-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, which ranges up to $141 for a three-month supply depending on your pharmacy selection. For higher-tier prescriptions, you will pay a coinsurance rather than a flat copay, which includes 47% coinsurance for Tier 4 non-preferred drugs and 29% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The Humana Gold Plus H1036-137 (HMO-POS) plan offers robust core medical coverage with no copay and no coinsurance for primary care visits, preventive screenings, and home health care. Specialist visits require a low $20 copay, while emergency services carry a $115 copay that is waived if you are admitted to the hospital. Inpatient hospital stays require a $375 daily copay for the first several days of acute or psychiatric care, with no copay required for subsequent days. For supplemental care, members enjoy routine dental, vision, and hearing exams with no copay, including up to $1,500 in dental coverage and a $250 annual allowance for eyewear. Skilled nursing facility stays feature no copay for the first 20 days, while durable medical equipment and dialysis services require a 20 percent coinsurance. Over-the-counter items and chronic meal benefits are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H1036-137 (HMO-POS) offers partially covered inpatient hospital benefits with no coinsurance and prior authorization required. Acute care requires a $375 copay for days 1 to 7 and no copay for days 8 and beyond, while psychiatric care has a $375 copay for days 1 to 5 and no copay for days 6 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H1036-137 (HMO-POS) with no coinsurance for all categories, though prior authorization is required. Ambulatory surgical center and outpatient blood services feature no copay, while outpatient hospital services have a copay ranging from $0 to $450 (including a $375 copay per observation stay) and outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus H1036-137 (HMO-POS) plan with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-137 (HMO-POS) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H1036-137 (HMO-POS) covers emergency services with a $115 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits under Humana Gold Plus H1036-137 (HMO-POS) include primary care physician visits with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Other covered services, such as physical therapy ($25 copay), mental health services ($35 copay), and telehealth ($0 to $40 copay), also require no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H1036-137 (HMO-POS) covers preventive services—including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, and a memory fitness benefit—with no copayments and no coinsurance. Additional preventive services are only partially covered, as the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, or counseling.
Hearing Services See details
Humana Gold Plus H1036-137 (HMO-POS) provides hearing services with no deductible, featuring routine hearing exams, fitting evaluations, and OTC hearing aids for no copay and no coinsurance. Medicare-covered exams require a $20 copay and no coinsurance, while prescription hearing aids are partially covered with a $399 to $699 copay and no coinsurance for up to two devices per year, excluding inner ear, outer ear, and over-the-ear models.
Vision Services See details
Humana Gold Plus H1036-137 (HMO-POS) offers partially covered vision services with no copay and no coinsurance for routine eye exams and covered eyewear, up to a $250 annual limit. While contact lenses and eyeglasses (lenses and frames) are covered, other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-137 (HMO-POS) offers partially covered dental services up to a $1,500 annual maximum, with a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered by this plan.
Home Infusion bundled Services See details
Humana Gold Plus H1036-137 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance up to a 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1036-137 (HMO-POS) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus H1036-137 (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Covered diabetic supplies carry a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-137 (HMO-POS) covers diagnostic and radiological services with prior authorization, featuring no coinsurance and no copay for lab services, and diagnostic test copays ranging from $0 to $120. Radiological benefits include outpatient X-rays with no copay, diagnostic radiology with a $0 minimum copay, and therapeutic radiology starting at a 20% coinsurance and $20 copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H1036-137 (HMO-POS) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-137 (HMO-POS) covers some cardiac rehabilitation services with no coinsurance and prior authorization required, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-137 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1036-137 (HMO-POS) covers acupuncture with a $20 copay, no coinsurance, and a limit of 20 treatments per year, subject to prior authorization. Over-the-counter (OTC) items and meal benefits for chronic illnesses are also covered with no copay and no coinsurance, though meal benefits require prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved