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Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) in 2025, please refer to our full plan details page.
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 Charlotte Metro Area. This plan received an overall rating of 4 out of 5 stars in 2025.
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.
Important:
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
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.
For Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.20. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $590.00 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 $9350.00 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 SNP-DE H1036-167 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay costs for your drugs until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), you will pay $51.20 for Part D. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance. Emergency and hearing services, along with vision and dental services, are covered. The plan also includes coverage for home health, skilled nursing facilities, and other services like acupuncture, meal benefits, and over-the-counter items. Preventive services, such as annual physical exams and fitness benefits, are covered with no copay. The plan offers coverage for ambulance, dialysis, medical equipment, and home infusion services. Primary care, vision, dental, and other services also have coverage.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization, with copays of $2185 and $2036, respectively, per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services and Observation Services, both with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) plan. Ground and air ambulance services have a copay of $315, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) plan, with a $110 copay, and no coinsurance, but the copay is waived if admitted to the hospital within 24 hours. Urgently Needed Services have no copay, but a 20% coinsurance applies. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) plan covers primary care, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Individual and Group Sessions for Mental Health and Psychiatric services have a 20% coinsurance. Occupational Therapy, Opioid Treatment Program Services, and Other Health Care Professional services have a 20% coinsurance. Podiatry Services are not covered, while Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include Medicare-covered zero dollar preventive services, an annual physical exam with no copay, and additional preventive services, including fitness benefit with no copay. Health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), 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, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with no copay for all types of hearing aids. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance. Eyewear benefits are also covered, including contact lenses and eyeglasses (lenses and frames) with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered and include Medicare Dental Services with 20% coinsurance, and other dental services with a $4,000 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay, but fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery are covered with 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, though prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay and between 0% and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance with no copay.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 20% coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts. The plan also covers Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) plan. Diagnostic Procedures/Tests have a coinsurance of at most 20%, and Lab Services have a coinsurance of at most 20% with no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $325, while Outpatient X-Ray Services have a coinsurance of at most 20% and a $50 copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) 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 covered, but the plan does not cover any of the sub-services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include acupuncture with 20% coinsurance, and a meal benefit with no copay. Over-the-counter items are covered up to $2700 per year, and some services are covered, but 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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