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Humana Gold Plus SNP-DE H1036-213 (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 H1036-213 (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 H1036-213 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Counties: LAK, MRN, ORA, OSC, SEM, SUM. 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 H1036-213 (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 H1036-213 (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 H1036-213 (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 H1036-213 (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 $320.00 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 H1036-213 (HMO D-SNP) plan has a $320 annual drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a standard pharmacy or preferred mail-order service. If you choose standard mail order, Tier 1 drugs have a $10 copay for a 1-month supply and Tier 2 drugs have a $20 copay. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands and Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy, preferred mail order, and standard mail-order fills. Tier 5 specialty tier drugs carry a 29% coinsurance for a 1-month supply across all available pharmacy types.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) plan offers comprehensive coverage with no copay and no coinsurance for the vast majority of medical services. This includes inpatient and outpatient hospital stays, primary and specialist doctor visits, diagnostic tests, and home health care. Members also enjoy no copays or coinsurance for dental, vision, and hearing services, which feature generous allowances such as a $4,000 annual dental limit and a $600 yearly vision allowance. While most services require prior authorization or referrals, emergency room visits carry a $75 copay that is waived upon hospital admission. Additionally, the plan covers unlimited transportation to approved locations with no copay or coinsurance. This plan is designed to minimize out-of-pocket healthcare costs for eligible members.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, subject to prior authorization. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and no coinsurance. Prior authorization and referrals are required for these benefits, which also feature no deductible for outpatient blood services.
Partial Hospitalization See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) covers partial hospitalization with no copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP), though prior authorization is required. Ground ambulance services have no copay (coinsurance applies), air ambulance services require a copay and 20% coinsurance, and transportation is partially covered with no copay or coinsurance for unlimited trips to plan-approved locations only.
Emergency Services See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) covers emergency services with a $75 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $75 copay and no coinsurance.
Primary Care See details
Primary Care benefits for the Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) are covered with no copay and no coinsurance for primary care physician visits, specialists, mental health, therapies, podiatry, and telehealth. Chiropractic services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered by Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) with no copay and no coinsurance for covered options like annual exams, kidney education, and select screenings. However, several sub-services are not covered, including health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) covers hearing exams, fitting evaluations, and OTC hearing aids with no copays and no coinsurance. Prescription hearing aids are partially covered up to $1,800 per ear every two years with no copay or coinsurance, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible. The plan covers one routine eye exam per year and provides a $600 annual allowance for contact lenses and eyeglasses (lenses and frames), while other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) provides partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $4,000. While diagnostic, preventive, and restorative services are covered, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B drugs—including chemotherapy, radiation, and insulin—are also provided with no copay and no coinsurance, though step therapy may apply.
Dialysis Services See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) covers dialysis services with no copay and no coinsurance. Members must obtain a referral and prior authorization before receiving treatment.
Medical Equipment See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with no copay and no coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) with no copayments and no coinsurance. These services, which include lab tests, diagnostic procedures, therapeutic radiology, and outpatient X-rays, require prior authorization and a referral.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) covers cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) with no copay and no coinsurance for days 1 through 100, though prior authorization is required. This benefit does not require a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) covers select other services with no copay and no coinsurance, including up to 25 acupuncture treatments per year, chronic illness meal benefits, and over-the-counter (OTC) items via reimbursement. Prior authorization is required for acupuncture and meal benefits, and other miscellaneous services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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