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Humana Gold Plus H1036-229 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-229 (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 H1036-229 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-229 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Treasure 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 H1036-229 (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 H1036-229 (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 H1036-229 (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 $2.00. 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 H1036-229 (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay for a 1-month or 3-month supply filled at standard pharmacies or through preferred mail order. If you utilize standard mail-order services, Tier 1 drugs have a $10 copay for a 1-month supply, while Tier 2 drugs carry a $20 copay. Tier 3 preferred brand drugs require a $30 copay for a 1-month supply at standard pharmacies and preferred mail order, which increases to a $47 copay for standard mail order. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 38% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply across all available pharmacy options.
Additional Benefits
The Humana Gold Plus H1036-229 (HMO) plan offers comprehensive medical coverage with many essential services featuring no copayments or coinsurance. You will pay no copay for primary care doctor visits, routine preventive services, and home health care, while specialist visits require a $35 copay. For inpatient hospital stays, there is a $270 daily copay for the first seven days and no copay for days eight through ninety, while emergency room visits carry a $150 copay. This Medicare Advantage plan also provides supplemental coverage for dental, vision, and hearing needs to help lower your out-of-pocket costs. Dental care is covered up to $1,000 annually with no copay for preventive services, and vision benefits include no copay for routine exams plus a $350 yearly eyewear allowance. Routine hearing exams and over-the-counter items are also available with no copay, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H1036-229 (HMO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $270 daily copay for days 1-7 and no copay for days 8-90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H1036-229 (HMO) covers outpatient services with no coinsurance, although prior authorization is required for most services. Outpatient hospital services have a copay of $0 to $300, observation services require a $270 copay per stay, and outpatient substance abuse sessions have a copay of $20 to $30. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H1036-229 (HMO) with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-229 (HMO) covers ground ambulance services with a copay of $0 to $240 and coinsurance, and air ambulance services with a 20% coinsurance and a copay. Transportation services are partially covered with no copay and no coinsurance for up to 24 yearly one-way trips to plan-approved locations, but transportation to any other health-related location is not covered.
Emergency Services See details
Humana Gold Plus H1036-229 (HMO) covers emergency services with a $150 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $15 copay, both featuring no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-229 (HMO) covers primary care visits with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Physical, occupational, and speech therapies require a $15 copay and no coinsurance, while chiropractic services are not covered because routine and other chiropractic care are excluded.
Preventive Services See details
Humana Gold Plus H1036-229 (HMO) covers preventive services, including annual physical exams, kidney disease education, and a memory fitness benefit, with no copay and no coinsurance. These benefits are only partially covered, as supplemental services such as health education, weight management, and nutritional counseling are not covered.
Hearing Services See details
Humana Gold Plus H1036-229 (HMO) hearing services are partially covered, offering annual routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are covered up to $1,000 per ear every two years with no copay and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H1036-229 (HMO) with no deductible or coinsurance, offering no copay for one annual routine eye exam and covered eyewear up to a $350 yearly limit. However, other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-229 (HMO) partially covers dental services up to a $1,000 annual limit, featuring no copay and no coinsurance for preventive care like cleanings and exams, and a $25 copay with no coinsurance for restorative services. Medicare-covered dental services require a $35 copay and no coinsurance, while fluoride, endodontics, periodontics, prosthodontics, implants, maxillofacial prosthetics, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-229 (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a 0% to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Humana Gold Plus H1036-229 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H1036-229 (HMO) covers durable medical equipment (DME) and diabetic supplies with a 20% coinsurance and no copay, subject to prior authorization. Prosthetic devices and diabetic therapeutic shoes or inserts are covered with no copay, while medical supplies require a 20% coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-229 (HMO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance. Outpatient diagnostic procedures have no coinsurance and a copay of $0 to $150, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $15 copay.
Home Health Services See details
Humana Gold Plus H1036-229 (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H1036-229 (HMO) with no coinsurance and require prior authorization. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-229 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $60 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1036-229 (HMO) provides partial coverage for other services, offering acupuncture for up to 25 treatments per year and over-the-counter items with no copay and no coinsurance. Meal benefits and other additional services are not covered under this plan.
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