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Humana Gold Plus H1036-151 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-151 (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 H1036-151 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1036-151 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Jackson, Gulf Coast, and North MS. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1036-151 (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 H1036-151 (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 H1036-151 (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 $3.00. 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 $590.00 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 $5900.00 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 H1036-151 (HMO) plan has an Enhanced Alternative drug benefit. The plan has a deductible of $590. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. In the initial coverage phase, the copays for a 30-day supply are $10-47 for generic drugs and 40% coinsurance for preferred brand drugs. Non-preferred drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H1036-151 (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. The plan also covers primary care, hearing, vision, and dental services, with copays that vary depending on the specific service. Emergency, ambulance, and skilled nursing facility services are covered as well. This plan includes additional services such as home health, home infusion, and dialysis services, with copays or coinsurance requirements. You'll also find coverage for medical equipment, diagnostic and radiological services, and cardiac rehabilitation. The plan also offers additional benefits such as acupuncture and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both with a $293 copay for days 1-7 and no copay for days 8-90; additional days for Inpatient Hospital-Acute have no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $295, and observation services with a $293 copay. Ambulatory surgical center services have no copay, while outpatient substance abuse services have a copay between $30 and $50 for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1036-151 (HMO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H1036-151 (HMO), including ground ambulance services with a $315 copay and air ambulance services with 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H1036-151 (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay.
Primary Care See details
The Humana Gold Plus H1036-151 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and physician specialist services with a $35 copay. The plan also covers mental health and psychiatric services, including individual and group sessions, with a $30 copay. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a copay between $0 and $55.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, and annual physical exams with no copay. Additional preventive services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services, 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 H1036-151 (HMO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $299 and $599, but 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 H1036-151 (HMO) plan covers vision services, including routine eye exams with a copay between $0 and $35, and eyewear, with a combined maximum plan benefit coverage of $200 per year. Contact lenses and eyeglasses (lenses and frames) have no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery, all with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $1500 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, but require prior authorization. The cost sharing for Medicare Part B Insulin Drugs includes a $35 copay and a coinsurance between 0% and 20%. The other drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus H1036-151 (HMO) plan. Durable Medical Equipment has a 12% coinsurance, while Prosthetic Devices have a 13% coinsurance and Medical Supplies have a 20% coinsurance; Diabetic Supplies have between 10% and 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered. Diagnostic procedures/tests have a copay between $0 and $55, lab services have no copay, diagnostic radiological services have a maximum copay of $325, and therapeutic radiological services have a copay between $40 and $45.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-151 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not the sub-services of 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. Prior authorization is required, and there is a copay for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H1036-151 (HMO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H1036-151 (HMO) plan covers acupuncture with a $35 copay, and a maximum of 20 treatments per year, and also covers a meal benefit with no copay. Other services, including over-the-counter items, and many other services, are not covered.
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