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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 2026, 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 4.5 out of 5 stars in 2026.
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 $3.00. 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 a $615.00 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 $3800.00 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 features an annual prescription drug deductible of $615. For generic drugs, members can take advantage of no copay for Tier 1 preferred generics and Tier 2 generics when using standard pharmacies or preferred mail-order services. If you choose standard mail order, Tier 1 drugs carry a $10 copay for a one-month supply, while Tier 2 drugs cost $20. For Tier 3 preferred brand drugs, copays start at $35 for a one-month supply at standard pharmacies and preferred mail order. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 49% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. This plan provides structured cost-sharing options to help manage your monthly prescription expenses.
Additional Benefits
The Humana Gold Plus H1036-217 (HMO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copay and no coinsurance for primary care physician visits, preventive care, and home health services. Specialist visits require a low $10 copay, while inpatient hospital stays have a $180 daily copay for the first five days and no copay for days six through 90. Emergency room care has a $150 copay that is waived if you are admitted within 24 hours, and urgent care is covered with no copay. This Medicare Advantage plan also includes key supplemental benefits, such as routine dental, vision, and hearing services with no copay, though annual coverage limits apply. Members can also benefit from over-the-counter items, meal benefits, and acupuncture with no copay, while major medical needs like dialysis and durable medical equipment generally require a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H1036-217 (HMO) partially covers inpatient hospital services with no coinsurance and a $180 daily copay for days 1 to 5, followed by no copay for days 6 to 90. While acute care includes unlimited additional days at no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H1036-217 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copays. Outpatient hospital services have a copay of $0 to $175 ($180 for observation), and outpatient substance abuse sessions have a copay of $10 to $35, with prior authorization and referrals required for most services.
Partial Hospitalization See details
Humana Gold Plus H1036-217 (HMO) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-217 (HMO) covers ground ambulance services with a copay of $0 to $240 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with both requiring prior authorization. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H1036-217 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-217 (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $10 copay and no coinsurance. Additional benefits like therapy, telehealth, and mental health services feature copays ranging from $0 to $35 and no coinsurance, though chiropractic services are only partially covered because routine and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H1036-217 (HMO) covers preventive services, including annual physicals and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus H1036-217 (HMO) covers hearing services with no deductible, including OTC hearing aids and annual routine exams and fittings with no copay and no coinsurance. Medicare-covered exams require a $10 copay and no coinsurance, while prescription hearing aids are partially covered with no coinsurance and copays between $199 and $1,299, though inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision Services are partially covered by Humana Gold Plus H1036-217 (HMO), featuring routine eye exams and eyewear with no copay and no coinsurance, up to a $500 annual maximum. Other eye exams, individual eyeglass lenses, separate eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
Humana Gold Plus H1036-217 (HMO) offers partially covered dental services up to a $1,500 yearly maximum, featuring no copay and no coinsurance for most preventive, diagnostic, and restorative care. Medicare-covered dental requires a $10 copay and no coinsurance, removable prosthodontics have no copay and 30% coinsurance, while fluoride, endodontics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-217 (HMO) covers home infusion bundled services with no copay, requiring prior authorization. Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while covered Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H1036-217 (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H1036-217 (HMO) covers medical equipment, offering durable medical equipment and diabetic supplies with a 20% coinsurance and no copay. Prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered with no copay and no coinsurance, with prior authorization required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H1036-217 (HMO), requiring prior authorization and referrals. Lab services feature no copay and no coinsurance, diagnostic procedures have no coinsurance with copays up to $150, and therapeutic radiological services require a minimum 20% coinsurance and a minimum $10 copay.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H1036-217 (HMO) plan with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-217 (HMO) covers Cardiac Rehabilitation Services with no coinsurance and a $10 copay, though prior authorization and referrals are required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H1036-217 (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay no copay for days 1 through 20 and a $160 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the Humana Gold Plus H1036-217 (HMO) plan are partially covered, featuring acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture, which is limited to 25 treatments per year, and meal benefits, while dual eligible SNPs with highly integrated services are not covered.
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