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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 2026, 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 4.5 out of 5 stars in 2026.
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. 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 $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 $2400.00 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 features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. Standard mail order for these generic tiers requires a copay of $10 to $20 for a one-month supply. Tier 3 preferred brand drugs require a $30 copay for a one-month supply at standard pharmacies and preferred mail order, increasing to $47 through standard mail order. Tier 4 non-preferred drugs incur a 47% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply across all available pharmacy and mail order channels.
Additional Benefits
The Humana Gold Plus H1036-146 (HMO) plan offers comprehensive medical coverage with minimal out-of-pocket costs for key healthcare services. Members pay no copay and no coinsurance for primary care visits, telehealth, home health care, and routine preventive services. For hospital stays, the plan features no coinsurance, with inpatient care requiring a $25 daily copay for the first four days and no copay for days five through 90. Additional benefits include routine dental, vision, and hearing care, which generally require no copay or coinsurance for preventive services. Dental care is covered up to a $1,500 annual limit, while routine vision exams and eyewear are covered up to a $400 annual limit with no copay. Members also benefit from up to 50 one-way transportation trips per year and acupuncture treatments with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H1036-146 (HMO) covers inpatient hospital services with no coinsurance, requiring a $25 daily copay for days 1 to 4 and no copay for days 5 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and psychiatric additional days are not covered.
Outpatient Services See details
Humana Gold Plus H1036-146 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services require a copay of $0 to $75 ($25 per stay for observation services), and outpatient substance abuse sessions carry a $5 to $25 copay, with prior authorizations and referrals required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H1036-146 (HMO) with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus H1036-146 (HMO), with ground ambulance services requiring a copay of up to $240 and air ambulance services requiring a 20% coinsurance. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H1036-146 (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 available with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-146 (HMO) provides primary care physician services and telehealth benefits with no copay and no coinsurance. Other covered services, including specialist visits, physical therapy, and mental health services, require copays ranging from $0 to $25 and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus H1036-146 (HMO) with no copay and no coinsurance for covered care, including annual physicals, kidney disease education, fitness benefits, and in-home support. However, several additional supplemental services are not covered, such as health education, home safety assessments, personal emergency response systems, and nutritional therapy.
Hearing Services See details
Humana Gold Plus H1036-146 (HMO) covers hearing services with no deductibles, featuring a $5 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. OTC hearing aids are covered with no copay or coinsurance, while prescription hearing aids are partially covered with no coinsurance and copays from $199 to $1,299, excluding inner ear, outer ear, and over-the-ear types.
Vision Services See details
Humana Gold Plus H1036-146 (HMO) provides partially covered vision services with no deductibles, no coinsurance, and no copays for covered routine eye exams and eyewear, which has a $400 annual limit. Other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-146 (HMO) provides partially covered dental services with a $1,500 annual limit, offering preventive care, diagnostics, and oral surgery with no copay and no coinsurance, alongside Medicare-covered dental for a $5 copay and no coinsurance. Removable prosthodontics are covered with no copay and a 30% coinsurance, while fluoride treatments, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-146 (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B chemotherapy and other drugs have a 0% to 20% coinsurance, while Medicare Part B insulin drugs are covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H1036-146 (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this care.
Medical Equipment See details
Humana Gold Plus H1036-146 (HMO) covers durable medical equipment (DME) and diabetic supplies with a 20% coinsurance and no copay. Prosthetic devices require a 10% coinsurance, while medical supplies and diabetic therapeutic shoes or inserts are covered with no copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-146 (HMO) covers diagnostic and radiological services, offering lab services and outpatient X-rays with no copay, and diagnostic procedures with a $0 to $25 copay and no coinsurance. Therapeutic radiological services require a minimum $5 copay and a minimum 20% coinsurance, with prior authorization and referrals required for all services.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H1036-146 (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-146 (HMO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus H1036-146 (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Under this plan, there is no copay for days 1 through 20 and a $160 daily copay for days 21 through 100, though additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Humana Gold Plus H1036-146 (HMO) partially covers other services, providing acupuncture (up to 25 treatments per year with prior authorization required) and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits and other additional services are not covered under this plan.
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