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Humana Gold Plus SNP-DE H1036-214 (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 H1036-214 (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 H1036-214 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Emerald Coast. 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 H1036-214 (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 H1036-214 (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 H1036-214 (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 H1036-214 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.10. 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 $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 H1036-214 (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, you will pay $8.10 for Part D drugs. During the initial coverage phase, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) plan offers comprehensive coverage with no copays for many services, including inpatient and outpatient hospital services, primary care, preventive services, hearing and vision exams, dental, home health, dialysis, and medical equipment. Emergency services have a $90 copay, while ambulance services have a copay between $0 and $100, and a 20% coinsurance for air ambulance. This plan also includes additional benefits such as transportation services, with no copay for up to 50 one-way trips per year, over-the-counter items up to $1200 per year, and a meal benefit for chronic illnesses. Prescription hearing aids are covered with a maximum of $1000 per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with no copay for a Medicare-covered stay, and no coinsurance. 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, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered with no copay. Prior authorization and a doctor referral are required for most of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) plan with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a copay between $0 and $100, and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay for up to 50 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a $90 copay, with no coinsurance. Urgently Needed Services have no copay and no coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, 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, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Individual and group sessions for mental health specialty services and psychiatric services have no copay. Occupational therapy services, other health care professional services, and opioid treatment program services have a $0 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services and kidney disease education services, with no copay for services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit.
Hearing Services See details
Hearing exams are covered with no copay, and also include services not usually covered by Medicare plans, but require prior authorization and a doctor referral. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids have a plan-specified amount per period, with a maximum of $1000 per 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, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear coverage, with no copay for either. Routine eye exams are limited to one per year, and eyewear has a combined maximum benefit of $400 per year. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Prosthodontics, fixed, and Oral and Maxillofacial Surgery with no copay; however, Fluoride Treatment, Maxillofacial Prosthetics, Implants, and Orthodontics are not covered. This plan has a maximum plan benefit coverage of $3,000 per year.
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. Medicare Part B Insulin Drugs, and Medicare Part B Chemotherapy/Radiation Drugs have no copay, while Other Medicare Part B Drugs have a minimum and maximum copay of $0.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) plan, but require prior authorization and a doctor's referral. There is no copay for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has no copay or coinsurance, while Durable Medical Equipment for use outside the home is not covered. Medicare-covered prosthetic devices and medical supplies have no coinsurance, but may have a copay. Diabetic supplies and therapeutic shoes/inserts have no copay or coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests and Outpatient X-Ray Services have no copay, while Lab Services, Diagnostic Radiological Services, and Therapeutic Radiological Services have a copay of $0.
Home Health Services See details
Home Health Services are covered 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 not covered under the Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but details about the copay are not provided. 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 H1036-214 (HMO D-SNP) plan covers acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year. Over-the-counter items are covered with a maximum benefit of $1200.00 per year, including nicotine replacement therapy and naloxone, but does not cover all drugs on the CMS OTC list. The plan also covers a meal benefit with no copay, and meals are provided for chronic illnesses.
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