Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP)

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 4.5 out of 5 stars in 2026.

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.

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.

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 H1036-209 (HMO D-SNP) plan features an annual drug deductible of $225. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. If you use standard mail order, you will pay a copay ranging from $10 to $30 for Tier 1 drugs and $20 to $60 for Tier 2 drugs. For Tier 3 preferred brand and Tier 4 non-preferred drugs, you will pay a 25% coinsurance across standard pharmacies, preferred mail order, and standard mail order options. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply at all available pharmacy and mail order channels. This plan structure helps beneficiaries understand their exact out-of-pocket costs for prescription medication.

Additional Benefits

The Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) plan offers comprehensive medical coverage with no copays and no coinsurance for most essential services, including primary care, specialist visits, preventive care, and diagnostic testing. For hospital and emergency needs, members experience highly affordable out-of-pocket costs, including a $50 copay per admission for inpatient stays and a $130 copay for emergency room visits. Additionally, most outpatient services, home health care, and dialysis are covered with no copay and no coinsurance. This plan also features generous supplemental benefits, including dental coverage with no copay and no coinsurance up to a $4,000 annual maximum. Members also pay no copay or coinsurance for vision and hearing care, which includes up to $400 annually for eyewear and up to $1,000 per ear annually for prescription hearing aids. Furthermore, ground ambulance services, over-the-counter items, and unlimited one-way trips to plan-approved health locations are provided with no copay and no coinsurance.