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Humana Gold Plus H1036-153 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-153 (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 H1036-153 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-153 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in OR. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H1036-153 (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 H1036-153 (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 H1036-153 (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 $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 $4750.00 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 H1036-153 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay at standard pharmacies or through preferred mail order. Tier 2 generic medications cost as low as a $12 copay for a one-month supply, with no copay required for a three-month supply filled via preferred mail order. For Tier 3 preferred brand drugs, copays start at $47 for a one-month supply at standard pharmacies and mail order services. Higher-tier prescriptions require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 45% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The Humana Gold Plus H1036-153 (HMO) plan offers comprehensive medical coverage with no coinsurance for inpatient hospital stays, which require a $395 daily copay for the first five days and no copay for days six through 90. Primary care visits, routine preventive services, and home health care are available with no copay, while specialist visits require a $30 copay. Emergency room visits feature a $130 copay, which is waived if you are admitted within 24 hours, and urgent care services require a $50 copay. This plan also includes valuable dental, vision, and hearing benefits, featuring up to $2,500 in annual dental coverage and routine vision and hearing exams with no copay. Prescription hearing aids require a copay of $599 to $899, while durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay. Additionally, members can access over-the-counter items and chronic illness meals with no copay.
Inpatient Hospital See details
Humana Gold Plus H1036-153 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $395 copay per day for days 1 to 5 and no copay for days 6 to 90. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H1036-153 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services and a $395 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse services have no coinsurance and a copay ranging from $0 to $35 per session.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H1036-153 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required for this service.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-153 (HMO) covers Medicare-approved ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, both featuring no coinsurance and requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H1036-153 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay 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 covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-153 (HMO) provides primary care and mental health services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Physical and occupational therapies have a $45 copay and no coinsurance, some chiropractic services are covered with a $15 copay and no coinsurance but routine and other chiropractic services are not, and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H1036-153 (HMO) preventive services are partially covered with no copay and no coinsurance for covered services like annual physicals, kidney disease education, glaucoma screenings, diabetes training, and memory fitness. However, 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, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H1036-153 (HMO) covers Medicare-covered hearing exams for a $30 copay and no coinsurance, while routine exams, fittings, and over-the-counter hearing aids are covered with no copay and no coinsurance. Prescription hearing aids are partially covered with a $599 to $899 copay and no coinsurance for up to two devices per year, though 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 H1036-153 (HMO) with no deductible and no coinsurance, featuring one routine eye exam per year with no copay. The plan also covers up to $100 annually for one pair of contact lenses or eyeglasses with no copay, though individual eyeglass lenses, frames, upgrades, and other eye exams are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H1036-153 (HMO), offering a $2,500 annual maximum with no copay or coinsurance for most preventive and comprehensive care, while Medicare-covered dental requires a $30 copay and no coinsurance. Non-covered services include fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Humana Gold Plus H1036-153 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Related Medicare Part B chemotherapy and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H1036-153 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H1036-153 (HMO) covers durable medical equipment, medical supplies, and prosthetic devices 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.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-153 (HMO) covers diagnostic and radiological services, though prior authorization is required. Diagnostic procedures and tests have a copay ranging from $0 to $50 with no coinsurance, while lab services and outpatient X-rays feature no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H1036-153 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-153 (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, although prior authorization is required. However, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-153 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 45, and no copay for days 46 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1036-153 (HMO) provides other services including acupuncture with a $30 copay and no coinsurance, as well as over-the-counter items and chronic illness meals with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while other miscellaneous benefits under this category are not covered.
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