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Humana Gold Plus H1036-217 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-217 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H1036-217 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H1036-217 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Gulf Coast. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1036-217 (HMO) 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 H1036-217 (HMO).
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 H1036-217 (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $3.50. You must continue to pay paying your reduced 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4150.00 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 H1036-217 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the standard pharmacy, you will pay no copay for preferred generic drugs, a $35 copay for standard generic drugs, and 48% coinsurance for preferred brand drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H1036-217 (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll find no copays for primary care visits, preventive services, and routine hearing and vision exams, along with dental services and home health services. This plan also covers ambulance services, emergency services, and offers coverage for hearing aids, eyewear, and some dental services. Other key benefits include coverage for home infusion, dialysis, and medical equipment, as well as skilled nursing facility services and cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For days 1-5, there is a $175 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with 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 all outpatient hospital services, with copays ranging from $0 to $175, and observation services with a $175 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have copays ranging from $10 to $100 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered with a $25 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a copay between $0 and $245, while air ambulance services have a 20% coinsurance. 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 H1036-217 (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $140 copay, while Urgently Needed Services has a $5 copay.
Primary Care See details
The Humana Gold Plus H1036-217 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $10 copay, occupational therapy services with a $10-$20 copay, physician specialist services with a $10 copay, and mental health specialty services with a $10 copay. This plan also covers podiatry services, other health care professional services with a $0-$10 copay, psychiatric services with a $10 copay, physical therapy and speech-language pathology services with a $10-$20 copay, additional telehealth benefits with a $0-$10 copay, and opioid treatment program services with a $10-$100 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and other preventive services that may require a copay. The plan also covers In-Home Support Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Humana Gold Plus H1036-217 (HMO) covers hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $199 and $1299, and OTC hearing aids are covered up to $100 every three months. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$10, and routine eye exams have no copay. Eyewear includes contact lenses and eyeglasses (lenses and frames) with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered. There is a combined maximum plan benefit coverage of $400 per year for all eyewear.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $10 copay, and Other Dental Services with a $1,500 maximum benefit per year. Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services have no copay. Fluoride Treatment, Endodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered. Prosthodontics, removable has a 30% coinsurance and no copay. Oral and Maxillofacial Surgery has no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%, and for other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance, and Diabetic Supplies have a 20% coinsurance. 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 include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests. Lab services have no copay, and radiological services include copays for Medicare-covered diagnostic and therapeutic radiological services and X-rays, as well as coinsurance for Medicare-covered X-ray services.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-217 (HMO) plan 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 covered, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation, Medicare-covered Pulmonary Rehabilitation, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD), and Additional Cardiac Rehabilitation Services are not covered. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $150.
Other Services See details
Other Services includes coverage for acupuncture with no copay and OTC items. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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 are not covered.
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