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Humana Gold Plus SNP-DE H1036-210 (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 H1036-210 (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 H1036-210 (HMO D-SNP) in 2025, please refer to our full plan details page.

Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Jacksonville 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 H1036-210 (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 H1036-210 (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.

Overview IconKey Plan Facts

Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H1036-210 (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 H1036-210 (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 $540.00 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:

Regular visits to your primary care doctor are covered and will have a copay of $0.00 and coinsurance of 0% (no coinsurance).

Specialist Visits:

Visits to specialists are covered and will have a copay of $0.00 and coinsurance of 0% (no coinsurance). Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a copay of $120.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care arecovered and will have a copay of $0.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP)

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Drug Coverage IconDrug Coverage

The Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) plan has a $540 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy. For preferred generic drugs, you will have no copay at a preferred pharmacy or via mail order, and a $20 copay at a standard pharmacy. Standard generic drugs have a $47 copay, and preferred brand and non-preferred drugs have a 25% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.

Additional Benefits IconAdditional Benefits

The Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) plan offers comprehensive coverage with many services at no copay, including inpatient and outpatient hospital services, primary care visits, preventive services, hearing and vision exams, dental services, and home health services. The plan also provides coverage for ambulance and transportation services, emergency and urgent care, and home infusion services. There are some services that are not covered, such as cardiac rehabilitation services, and some services that require a copay, such as emergency services and some ambulance services.

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both with no copay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, 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 include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center Services, and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have no copay for both individual and group sessions.

Partial Hospitalization See details

Partial hospitalization is covered by the Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) plan, with a $0 copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, including Ground Ambulance Services with a copay between $0 and $100, and Air Ambulance Services with 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 50 one-way trips per year, and transportation includes taxi, bus/subway, and medical transport. Transportation Services to any health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) plan. Emergency Services has a $120 copay, and no coinsurance. Urgently Needed Services has no copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay, and no coinsurance.

Primary Care See details

The Humana Gold Plus SNP-DE H1036-210 (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, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Chiropractic Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a $0 copay. Routine Chiropractic Care is not covered.

Preventive Services See details

Preventive Services include no copay for an annual physical exam, and no copay for additional services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. This plan also offers no copay for Wigs for Hair Loss Related to Chemotherapy, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefits.

Hearing Services See details

Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids (all types) are covered with a plan-specified amount per period. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.

Vision Services See details

Vision services include coverage for eye exams and eyewear. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.

Dental Services See details

The Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) plan covers dental services, 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, all with no copay; however, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit coverage of $3,000 per year.

Home Infusion bundled Services See details

Home Infusion bundled Services, including Medicare Part B Insulin Drugs and Medicare Part B Chemotherapy/Radiation Drugs, are covered with no copay, while Other Medicare Part B Drugs have a copay of $0. Prior authorization is required for these services.

Dialysis Services See details

Dialysis Services are covered by Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP), but require prior authorization and a doctor referral. There is no copay for this benefit.

Medical Equipment See details

Medical Equipment benefits include Durable Medical Equipment (DME) with no coinsurance and no copay, Prosthetics/Medical Supplies with no coinsurance and a copay for Medicare-covered devices and supplies, and Diabetic Equipment, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, with no coinsurance and 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, and require prior authorization and a doctor's referral. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a copay of $0.

Home Health Services See details

Home Health Services are covered by the Humana Gold Plus SNP-DE H1036-210 (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 not covered by the Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered, but there is no information about the copay or coinsurance for this benefit. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.

Other Services See details

The Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) plan covers acupuncture with no copay, and also covers Over-the-Counter (OTC) items up to $1200 per year, as well as a meal benefit with no copay. The plan does not cover 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.

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