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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 2026, 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 Gulf Coast, Jackson, Hattiesburg, Memphis. 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 H1036-222 (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 $23.80. 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 $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 $9250.00 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 H1036-222 (HMO D-SNP) Medicare plan has a yearly drug deductible of $615. Beneficiaries pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled through standard pharmacies or preferred mail order services. If you choose standard mail order, Tier 1 generics have a $10 copay for one month and a $30 copay for three months, while Tier 2 generics require a $20 or $60 copay respectively. For Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, the plan charges a flat 25% coinsurance. This 25% coinsurance applies to one-month and three-month supplies across standard pharmacies, preferred mail order, and standard mail order options. Understanding these cost-sharing tiers helps you estimate your annual out-of-pocket prescription costs on this Humana HMO D-SNP plan.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) offers robust medical coverage, featuring no copay and a 20 percent coinsurance for primary care, specialist visits, and dialysis. Inpatient hospital stays require a flat copay with no coinsurance, while skilled nursing facility care is available with no copay for the first 20 days. Emergency room visits carry a $115 copay that is waived if you are admitted, and routine home health services are provided with no copay or coinsurance. This plan also includes valuable everyday benefits, such as preventive care, over-the-counter items, and chronic illness meals with no copay or coinsurance. Members enjoy generous allowances, including up to $4,000 annually for select dental services and a $300 annual limit for eyewear, both with no copay or coinsurance. Additionally, the plan covers routine hearing exams and provides up to 36 one-way trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring prior authorization and a copay of $2,230 per stay for acute care and $2,080 per stay for psychiatric care. While unlimited additional days are covered for acute care, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) covers outpatient hospital services with a $550 copay and 20% coinsurance, and ambulatory surgical center services with a $400 copay and 20% coinsurance. Outpatient substance abuse and blood services are covered with no copay and a 20% coinsurance, and most outpatient services require prior authorization.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) with no copay and a 20% 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 H1036-222 (HMO D-SNP), with transportation being partially covered as services to any health-related location are not covered. Ground ambulance services require a $335 copay and coinsurance, air ambulance services require a 20% coinsurance and a copay, and up to 36 yearly one-way trips to plan-approved locations are offered with no copay and no coinsurance.
Emergency Services See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a 20% coinsurance (up to $40) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) covers primary care, specialist, mental health, and therapy services with no copay and 20% coinsurance. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive services are partially covered with no copay and no coinsurance, though health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) covers hearing services with no deductible, offering routine hearing exams with no copay and 20% coinsurance, and fitting evaluations and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two devices every three years, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) offers partially covered vision services with no deductible, though prior authorization is required. Routine eye exams are covered with no copay and a 20% coinsurance, and select eyewear has no copay or coinsurance up to a $300 annual limit, while other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) covers Medicare-covered dental services with no copay and a 20% coinsurance. Other dental services are partially covered up to a $4,000 annual maximum with no copay and no coinsurance, though fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) covers home infusion bundled services with prior authorization and step therapy requirements. Covered Part B drugs incur 0% to 20% coinsurance, with insulin requiring a $35 copay, chemotherapy drugs requiring a copay, and other Part B drugs having no copay.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to obtain these services.
Medical Equipment See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) covers diagnostic and radiological services with prior authorization and a 20% coinsurance. Under this plan, diagnostic procedures and lab services have no copay, while outpatient X-rays carry a $50 copay and diagnostic radiological services carry a $200 copay.
Home Health Services See details
Home health services are covered under the Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay under Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP), but prior authorization is required. However, specific services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not needed, though additional days beyond the 100-day Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) partially covers other services, including acupuncture with no copay and 20% coinsurance, alongside over-the-counter items and chronic illness meals with no copay and no coinsurance. Highly integrated services for dual eligible SNPs are not covered under this benefit.
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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