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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 2025, 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 out of 5 stars in 2025.
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 $125.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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 has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, but $20 at a standard mail-order pharmacy. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus Giveback H1036-157 (HMO) plan offers a range of benefits, including no copay for primary care, preventive services, and routine vision and dental services. The plan also provides coverage for inpatient hospital stays, outpatient services, and emergency services with varying copays, as well as coverage for hearing exams and prescription hearing aids. Additional benefits include coverage for ambulance and transportation services, home health services, and skilled nursing facility stays. The plan also covers home infusion bundled services, dialysis services, and medical equipment with some cost-sharing, along with acupuncture and a meal benefit at no copay.
Inpatient Hospital See details
Inpatient Hospital coverage for Humana Gold Plus Giveback H1036-157 (HMO) includes acute and psychiatric care with a $175 copay for days 1-7 and no copay for days 8-90. Additional days for inpatient hospital-acute have no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $195, observation services with a $175 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a copay between $25 and $50 for individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground ambulance services with a copay between $0 and $250, and air ambulance services with a 20% coinsurance. Transportation Services to plan-approved health-related locations are covered with no copay, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered, with a $140 copay for emergency services and worldwide emergency coverage, and a $15 copay for urgently needed services. Worldwide urgent coverage and worldwide emergency transportation also have a $140 copay.
Primary Care See details
The Humana Gold Plus Giveback H1036-157 (HMO) plan covers Primary Care services with no copay. Chiropractic services have a $20 copay, while Routine Chiropractic Care is not covered. Occupational Therapy Services have a copay ranging from $10 to $35, and Physician Specialist Services have a $25 copay. Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services all have a $25-$50 copay. Physical Therapy and Speech-Language Pathology Services have a copay ranging from $10 to $35. Additional Telehealth Benefits have a copay ranging from $0 to $25.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services, Kidney Disease Education Services, and other preventive services. Additional preventive services require prior authorization, and the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, support for caregivers of enrollees, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, counseling services. Other services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with no copay.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a copay between $199 and $1299, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses (lenses and frames), has no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $25 copay, and other dental services with a $1,500 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Fluoride treatment, endodontics, maxillofacial prosthetics, implant services, prosthodontics fixed, and orthodontics are not covered. Prosthodontics, removable has a 30% coinsurance, and oral and maxillofacial surgery has no copay.
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. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus Giveback H1036-157 (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with coinsurance and copays for some services. Diabetic Equipment is also covered, with specific cost-sharing details for different services like Diabetic Therapeutic Shoes/Inserts that have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $195, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $175, Therapeutic Radiological Services with a copay between $25 and $50, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus Giveback H1036-157 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus Giveback H1036-157 (HMO) plan. Prior authorization and a doctor's referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus Giveback H1036-157 (HMO) plan. There is no copay for days 1-20, and a $150 copay for days 21-100, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus Giveback H1036-157 (HMO) plan covers acupuncture with no copay, and covers a meal benefit with no copay. However, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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