Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)

Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in North Carolina. This plan received an overall rating of 4.5 out of 5 stars in 2026.

It's important to know that Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) 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 SNP-DE H1036-167 (HMO D-SNP).

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.

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:

Drug Coverage

The Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members enjoy no copay for 1-month and 3-month supplies filled at standard retail pharmacies or through preferred mail order. If you utilize standard mail order for these generic tiers, you will pay a copay of $10 to $20 for a 1-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan requires a 25% coinsurance for standard pharmacy and mail order services. This 25% coinsurance applies to both 1-month and 3-month fills for Tiers 3 and 4, and 1-month fills for Tier 5 specialty drugs. These clear cost-sharing tiers make it easy to estimate your out-of-pocket prescription costs under this plan.

Additional Benefits

The Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) offers comprehensive medical coverage, featuring no copay and a 20% coinsurance for primary care, specialist visits, and outpatient hospital services. Inpatient hospital stays require no coinsurance but carry a copay of $2,230 per stay for acute care and $2,080 per stay for psychiatric care, with unlimited additional acute care days available at no copay. Emergency care is accessible with a $115 copay, which is waived if you are admitted, while ground and air ambulance services require a $335 copay with no coinsurance. This plan also provides robust supplemental benefits, including preventive services and home health care with no copay and no coinsurance. Dental services are covered up to a $4,000 annual maximum with no copay and no coinsurance for most preventive and comprehensive care, alongside a $350 annual eyewear allowance and coverage for hearing aids with no copay or coinsurance. Additionally, members can benefit from covered over-the-counter items and chronic illness meals with no copay and no coinsurance, though many services require prior authorization.