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Humana Gold Plus SNP-DE H1036-226 (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 H1036-226 (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 H1036-226 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Treasure 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 H1036-226 (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 H1036-226 (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 H1036-226 (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 H1036-226 (HMO D-SNP), 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.
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 $6650.00 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 H1036-226 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay 25% coinsurance for most drugs. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) plan offers a wide range of benefits with many services having no copay, including primary care visits, outpatient services, and dental services. The plan includes coverage for inpatient hospital stays with a copay for the first few days, and also covers hearing and vision services, along with medical equipment. Emergency services have a copay, and transportation services are covered, with both ground and air ambulance options.
Inpatient Hospital See details
Inpatient hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-7, the copay is $100, and for days 8-90, there is no copay; additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with no copay, observation services with a $100 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with no copay for individual and group sessions, and outpatient blood services with no copay. These services require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization and no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground Ambulance Services have no copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to a plan-approved health-related location have no copay, and offer up to 50 one-way trips per year via taxi, bus/subway, or medical transport. 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. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $115 copay, while Urgently Needed Services have no copay.
Primary Care See details
The Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay. However, routine chiropractic care is not covered.
Preventive Services See details
The Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including wigs for hair loss, additional sessions of smoking and tobacco cessation counseling, and fitness benefits (memory fitness) are covered with no copay. Other services like health education, in-home safety assessment, and others are not covered.
Hearing Services See details
The Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) plan covers hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay, limited to one visit per year. Prescription hearing aids are covered, with a maximum plan benefit coverage of $1000 per ear every year, and prescription hearing aids (all types) are covered with no copay for two visits per year; however, prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and eyewear have no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $3,000 annual maximum. 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 and fixed), and Oral and Maxillofacial Surgery are covered with no copay, while Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs and Medicare Part B Chemotherapy/Radiation Drugs have no copay, and 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 H1036-226 (HMO D-SNP) plan. There is no copay for dialysis services, but prior authorization and a doctor's referral are required.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered. Durable Medical Equipment (DME) has no coinsurance and no copay, and Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, lab services, and outpatient x-rays, are covered by the Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) plan. Lab services, diagnostic procedures, and outpatient x-rays have no copay, and other diagnostic and radiological services may have a copay of at most $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 by the Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the plan does not specify the copay.
Other Services See details
Under the "Other Services" benefit, acupuncture is covered with no copay, but is limited to 25 treatments per year and requires prior authorization. This plan also covers over-the-counter items with a yearly maximum benefit of $1200, and also covers a meal benefit with no copay and requires prior authorization. This 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, and Self-Directed Personal Assistance Services.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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