A non-government entity
Humana Gold Plus SNP-DE H1036-222 (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 H1036-222 (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 H1036-222 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Mississippi. 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 H1036-222 (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 H1036-222 (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 H1036-222 (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 H1036-222 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.30. 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 $9350.00 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:
Sign up for Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for Medicare Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), and in that case the monthly Part D premium is $47.30.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) plan offers a range of benefits, including inpatient hospital stays with copays, outpatient services with coinsurance, and ambulance and transportation services. This plan also includes coverage for primary care, preventive, hearing, vision, and dental services, with varying cost-sharing structures like copays and coinsurance. Additionally, the plan provides coverage for medical equipment, home health services, and other services like acupuncture and over-the-counter items, while excluding certain services such as cardiac rehabilitation and additional days in a skilled nursing facility.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered. For Inpatient Hospital-Acute, the copay is $2,185 per stay. For Inpatient Hospital-Psychiatric, the copay is $2,036 per stay, and Additional Days are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $550 copay and 20% coinsurance, Observation Services with 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a $400 copay and 20% coinsurance, Individual and Group Sessions for Outpatient Substance Abuse with 20% coinsurance, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a 19% coinsurance. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) plan, with a $315 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to a plan-approved health-related location are covered with no copay for up to 36 one-way trips per year.
Emergency Services See details
Emergency Services for Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) include a $110 copay, and no coinsurance. Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay, with no coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) plan covers primary care physician services with a 20% coinsurance, chiropractic services with a 20% coinsurance, and routine chiropractic care with no copay. The plan also covers occupational therapy services, physician specialist services, physical therapy and speech-language pathology services, additional telehealth benefits, and Opioid Treatment Program services with a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services, including wigs for hair loss, additional sessions of smoking and tobacco cessation counseling, and fitness benefits with no copay. Other services such as health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing services include routine hearing exams with no copay and a coinsurance of at most 20%, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, and are limited to 2 every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear. Eyewear includes contact lenses and eyeglasses (lenses and frames), with a combined maximum plan benefit of $250 per year and no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $2000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay, while fluoride treatment and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics (fixed) have no copay, while oral and maxillofacial surgery has no copay. Prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
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 have a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance of 0-20% with no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment with varying coinsurance and copays. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, with Lab Services also having no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $720, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%, with Outpatient X-Ray Services also having a $50 copay.
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 by the Humana Gold Plus SNP-DE H1036-222 (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 by the Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay per day for days 21-100. 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 H1036-222 (HMO D-SNP) plan covers acupuncture with 20% coinsurance and a limit of 20 treatments per year, and over-the-counter (OTC) items with a maximum benefit of $1200 per year. The plan also covers a meal benefit with no copay. However, the plan does not cover 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, or Self-Directed Personal Assistance Services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved