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Humana Gold Plus Giveback H1036-157 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-157 (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 Giveback H1036-157 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-157 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Flagler and Volusia counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus Giveback H1036-157 (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 Giveback H1036-157 (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 Giveback H1036-157 (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 $136.00. 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 $3700.00 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 Giveback H1036-157 (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members enjoy no copay for one-month or three-month supplies when using standard retail pharmacies or preferred mail-order services. Standard mail-order options for these generic drugs range from a $10 to $20 copay for a one-month supply. Tier 3 preferred brand drugs cost a $30 copay for a one-month supply at standard pharmacies or preferred mail-order, and up to $141 for a three-month standard mail-order supply. Tier 4 non-preferred drugs require a 45% coinsurance across all fulfillment methods, while Tier 5 specialty drugs require a 25% coinsurance for a one-month supply.
Additional Benefits
The Humana Gold Plus Giveback H1036-157 (HMO) plan offers medical coverage featuring no coinsurance and no copay for primary care doctor visits, alongside a $25 copay for specialist visits. For hospital stays, members pay no coinsurance and a $175 daily copay for inpatient days 1 through 7, followed by no copay for days 8 through 90. Outpatient hospital services carry no coinsurance and a copay ranging from no copay to $195, while emergency room visits require a $150 copay that is waived upon admission. Supplemental benefits include routine dental care with no copay or coinsurance up to a $1,500 annual maximum, and routine vision exams and eyewear with no copay and a $300 annual allowance. Routine hearing exams have no copay, while prescription hearing aids require no coinsurance and copays between $199 and $1,299. Additionally, members receive transportation for up to 50 one-way trips per year to plan-approved locations with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus Giveback H1036-157 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $175 daily copay for days 1 through 7, followed by no copay for days 8 through 90. Prior authorization is required, and while unlimited additional acute days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus Giveback H1036-157 (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $195, observation services carry a $175 copay per stay, and outpatient substance abuse sessions have a copay of $25 to $35.
Partial Hospitalization See details
Humana Gold Plus Giveback H1036-157 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus Giveback H1036-157 (HMO) covers ground ambulance services with a copay of $0 to $240 and air ambulance services with a 20% coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 50 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus Giveback H1036-157 (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $15 copay with no coinsurance, while worldwide emergency, urgent care, and emergency transportation are all covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Giveback H1036-157 (HMO) offers primary care doctor visits with no copay and telehealth benefits with no copay to a $25 copay, both with no coinsurance. Specialist visits, mental health, psychiatric, and podiatry services have a $25 copay and no coinsurance, while physical, occupational, and speech therapies range from a $10 to $35 copay with no coinsurance; chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus Giveback H1036-157 (HMO) preventive services are partially covered, featuring no copay and no coinsurance for covered options such as annual physicals, kidney disease education, and diabetes self-management training. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus Giveback H1036-157 (HMO) covers hearing services with no deductible, offering Medicare-covered exams for a $25 copay and no coinsurance, while annual routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199 to $1,299, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus Giveback H1036-157 (HMO) partially covers vision services with no coinsurance and no copayments for covered routine eye exams and eyewear, which includes up to $300 annually for contact lenses or eyeglasses (lenses and frames). Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Giveback H1036-157 (HMO) partially covers dental services up to a $1,500 annual maximum, offering Medicare dental services for a $25 copay and no coinsurance, and most other preventive and comprehensive services with no copay and no coinsurance. Removable prosthodontics are covered with no copay and a 30% coinsurance, while fluoride, endodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H1036-157 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus Giveback H1036-157 (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by the Humana Gold Plus Giveback H1036-157 (HMO) with prior authorization required, featuring a 20% coinsurance and no copay for durable medical equipment, prosthetic devices, and diabetic supplies. Medical supplies and diabetic therapeutic shoes or inserts are covered with no copay and no coinsurance, though diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus Giveback H1036-157 (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Lab services and outpatient X-rays feature no copay, while diagnostic procedures range from a $0 to $195 copay and therapeutic radiological services require a minimum copay of $25.
Home Health Services See details
Humana Gold Plus Giveback H1036-157 (HMO) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Humana Gold Plus Giveback H1036-157 (HMO) provides coverage for some Cardiac Rehabilitation Services with no coinsurance, but specific sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered. These non-covered rehabilitation services require copays ranging from $20.00 to $25.00, with no coinsurance required.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H1036-157 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $160 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus Giveback H1036-157 (HMO) partially covers other services, offering acupuncture (up to 25 treatments per year) and meal benefits for chronic illnesses with no copay and no coinsurance, though prior authorization is required. Over-the-counter (OTC) items are not covered under this plan.
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