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Humana Gold Plus H1036-146 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-146 (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 H1036-146 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1036-146 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Counties: LAK, MRN, ORA, OSC, SEM, SUM. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1036-146 (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 H1036-146 (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 H1036-146 (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 $2600.00 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 H1036-146 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. Once your total drug costs reach $2,000, you enter the next coverage phase. In the catastrophic coverage phase, you pay nothing for your Part D covered drugs after your yearly out-of-pocket costs reach $2,000. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. This plan may also reduce your premium if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Humana Gold Plus H1036-146 (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $50 copay for the first four days, and no copay thereafter. The plan also covers outpatient services, primary care, preventive services, hearing, vision, and dental, each with varying copays or coinsurance. Additional benefits include ambulance and transportation services, emergency services, home health services, home infusion, and medical equipment coverage. Diagnostic, radiological, and skilled nursing facility services are also covered, along with acupuncture and over-the-counter items, with certain restrictions and copays, as well as the need for prior authorization for some services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $50 copay for days 1-4, and no copay for days 5-90; additional days (91-999) have no copay. Inpatient Hospital Psychiatric has a $50 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 outpatient hospital services with a copay between $0 and $75, observation services with a $50 copay, ambulatory surgical center services with no copay, individual and group outpatient substance abuse sessions with a copay between $5 and $25, and outpatient blood services with no copay. Prior authorization and a doctor's referral are required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1036-146 (HMO) plan. The plan has a $25 copay for this benefit and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, as well as transportation to plan-approved health-related locations. Ground ambulance services have a copay between $0 and $240, while air ambulance services have a 20% coinsurance; transportation services have no copay.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Humana Gold Plus H1036-146 (HMO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $5 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $140 copay.
Primary Care See details
The Humana Gold Plus H1036-146 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $5 copay, occupational therapy services with a $5-$20 copay, physician specialist services with a $5 copay, mental health specialty services with a $5 copay, podiatry services with a $5 copay, other health care professional services with a $0-$5 copay, psychiatric services with a $5 copay, physical therapy and speech-language pathology services with a $5-$20 copay, additional telehealth benefits with a $0-$5 copay, and opioid treatment program services with a $5-$25 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include Medicare-covered zero dollar services, an annual physical exam with no copay, and additional preventive services with a copay. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The Humana Gold Plus H1036-146 (HMO) plan covers hearing exams with a $5 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $199 and $1299, and over-the-counter hearing aids are covered up to $100 every three months.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$5.00, and eyewear with no copay, up to a combined maximum of $300 per year. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $1500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with no copay, though prosthodontics (removable) has a 30% coinsurance. 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, requiring prior authorization. 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, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1036-146 (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Humana Gold Plus H1036-146 (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and no copay, while Diabetic Supplies have a 20% coinsurance and no copay, and Prosthetic Devices have a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and outpatient X-ray services, are covered with a copay that varies from $0 to $25 depending on the specific service. Lab services are covered with no copay. Diagnostic Radiological Services have a copay of at most $75, and Therapeutic Radiological Services have a coinsurance of at least 20% and a copay of at least $5.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-146 (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 by the Humana Gold Plus H1036-146 (HMO) plan, but the specific services listed such as 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 are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H1036-146 (HMO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $160 copay for days 21-100, and additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H1036-146 (HMO) plan covers acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year, and also covers over-the-counter items with a $100 maximum benefit every three months, including nicotine replacement therapy and naloxone, but does not cover all drugs on the CMS OTC list. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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