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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 2026, 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 4.5 out of 5 stars in 2026.
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 $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 $250.00 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 $4900.00 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) medicare plan features an annual drug deductible of $250. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also budget-friendly, requiring a $10 copay for a 1-month supply at standard pharmacies or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs generally cost a $47 copay for a 1-month supply, though you can save with a $131 copay for a 3-month supply through preferred mail order. For advanced medications, Tier 4 non-preferred drugs require a 43% coinsurance, and Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply. These structured costs make it easy to plan your healthcare budget with the Humana Gold Plus H1036-151 (HMO) plan.
Additional Benefits
The Humana Gold Plus H1036-151 (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, annual physicals, and home health services. Specialist visits and physical therapies require a low $25 copay, while inpatient hospital stays carry a $260 daily copay for the first seven days and no copay for days eight through ninety. Emergency room visits require a $130 copay, which is waived if you are admitted, and urgent care is available for a $50 copay. For extra benefits, the plan provides a $2,500 annual dental allowance and a $250 annual vision allowance for eyeglasses or contacts with no copay or coinsurance. Routine hearing exams also have no copay, and the plan covers up to two prescription hearing aids per year with copays ranging from $299 to $599. Other services, such as durable medical equipment and dialysis, require a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Plus H1036-151 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $260 daily copay for days 1 through 7 and no copay for days 8 through 90. Unlimited additional acute days are covered with no copay, but psychiatric additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Humana Gold Plus H1036-151 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $270 copay for outpatient hospital services and a $260 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse sessions carry a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Gold Plus H1036-151 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services under the Humana Gold Plus H1036-151 (HMO) require prior authorization, offering ground ambulance services for a $335 copay with no coinsurance and air ambulance services for a 20% coinsurance with no copay. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H1036-151 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available for a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-151 (HMO) offers primary care physician visits with no copay and no coinsurance, while specialist visits and physical, occupational, or speech therapies require a $25 copay and no coinsurance. Mental health and psychiatric services carry a $35 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H1036-151 (HMO) covers annual physicals, kidney disease education, glaucoma screenings, and diabetes self-management with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, though prior authorization is required for covered services like fitness and in-home support. Uncovered sub-services include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus H1036-151 (HMO) with no coinsurance, featuring no copay for annual routine exams and fitting evaluations, and a $25 copay for Medicare-covered exams. Up to two prescription hearing aids are covered per year with copays ranging from $299 to $599, but OTC, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H1036-151 (HMO) with no copays, no coinsurance, and no deductibles, though prior authorization is required. Covered benefits include one routine eye exam per year and up to $250 annually for one pair of contact lenses or eyeglasses (lenses and frames), while other eye exam services, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-151 (HMO) partially covers dental services, offering a $2,500 annual maximum for most preventive and comprehensive care with no copay and no coinsurance, while Medicare-covered dental services require a $25 copay and no coinsurance. Under this plan, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-151 (HMO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H1036-151 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Humana Gold Plus H1036-151 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Humana Gold Plus H1036-151 (HMO) with prior authorization required. Diagnostic procedures carry a $0 to $50 copay with no coinsurance, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum $25 copay and a minimum 20% coinsurance.
Home Health Services See details
Humana Gold Plus H1036-151 (HMO) covers home health services with no copay and no coinsurance. Prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H1036-151 (HMO) with a $15 copay and no coinsurance, though prior authorization is required. This copayment applies to cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-151 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1036-151 (HMO) offers partial coverage for other services, featuring acupuncture with a $25 copay and no coinsurance (up to 20 treatments per year) and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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