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Humana Gold Plus SNP-DE H1036-209 (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 H1036-209 (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 H1036-209 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) is a HMO D-SNP 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 SNP-DE H1036-209 (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 H1036-209 (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 H1036-209 (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 H1036-209 (HMO D-SNP), 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.
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 $530.00 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 $3400.00 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 H1036-209 (HMO D-SNP) plan has a $530.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For a 30-day supply at a standard pharmacy, you'll pay no copay for preferred generic drugs, a $47.00 copay for standard generic drugs, and 25% coinsurance for preferred brand and non-preferred drugs. You will enter the catastrophic coverage phase after your total drug costs reach $2000.00.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) plan offers a wide range of benefits with no copay, including primary care, preventive services, vision, dental, home health, and many outpatient services. The plan includes coverage for inpatient hospital stays with a $50 copay, and emergency services with a $120 copay. Additional benefits include hearing services, transportation, and medical equipment, all with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $50 copay per admission or stay for Medicare-covered stays, while additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for Outpatient Hospital Services with no copay, Observation Services with a $50 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with no copay, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral are required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) plan, with no copay required. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services and transportation services to plan-approved health-related locations. Ground ambulance services have a copay ranging from $0 to $200, and air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations have no copay, and cover up to 50 one-way trips per year by taxi, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) plan. Emergency services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $120 copay and no coinsurance, and urgently needed services have no copay and no coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, individual and group sessions for mental health specialty services, podiatry services, other health care professional, psychiatric services, additional telehealth benefits, and opioid treatment program services have no copay. Occupational therapy services, physical therapy and speech-language pathology services have no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include annual physical exams with no copay, along with additional preventive services that may have a copay; specific services like health education, in-home safety assessments, and others are not covered. Wigs for hair loss related to chemotherapy, in-home support services, additional sessions of smoking and tobacco cessation counseling, and the fitness benefit have no copay. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a plan-specified amount per ear every year, and Prescription Hearing Aids (all types) are covered with no copay, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams and eyewear have no copay, and a $400 combined maximum plan benefit coverage amount is available every year for eyewear.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a maximum benefit of $4,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) plan, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, all with no copay. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. There is no copay for dialysis services.
Medical Equipment See details
Medical Equipment benefits are covered, with no coinsurance. Durable Medical Equipment has no copay, and Prosthetic Devices and Medical Supplies have no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered with no copay. Outpatient X-ray services, diagnostic radiological services, and therapeutic radiological services are also covered with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) plan with no copay and no coinsurance. However, 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 Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) plan, with a $0 copay for days 1-20, and a $95 copay for days 21-100; however, additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Under the Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) plan, acupuncture is covered with no copay, and up to 25 treatments are allowed per year. Over-the-counter (OTC) items are covered up to $1,500 per year, including nicotine replacement therapy and naloxone, although not all drugs on the CMS OTC list are covered. The plan also covers a meal benefit with no copay for chronic illnesses, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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