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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 2025, 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 out of 5 stars in 2025.
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 $4.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3850.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy, and 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H1036-229 (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. This plan covers primary care visits with no copay, and also includes benefits for hearing, vision, and dental services, with specific copays for exams and other services. Additional benefits include coverage for ambulance services, emergency services, and home health services with no copay. Other services like medical equipment, diagnostic and radiological services, and skilled nursing facilities are also covered, but may require prior authorization and have varying copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-7, and no copay for days 8-90. Additional Days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, nor are Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by this plan. Outpatient Hospital Services have a copay between $0 and $300, Observation Services have a $275 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services have a copay between $15 and $30 for both individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1036-229 (HMO) plan, with a $15 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Gold Plus H1036-229 (HMO) plan, with prior authorization required. Ground ambulance services have a copay of $0-$240, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, with no copay, while transportation services to any other 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 have a $140 copay, and Urgently Needed Services have a $15 copay; all have no coinsurance.
Primary Care See details
The Humana Gold Plus H1036-229 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $15 copay, and physician specialist services with a $35 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, opioid treatment program services, and additional telehealth benefits have varying copays. Physical therapy and speech-language pathology services have a $15 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services. Additional preventive services are covered, but there may be a copay. The plan also covers Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with a maximum benefit of $50 every three months. Prescription hearing aids are covered with a $500 maximum benefit per year, but specific types of prescription hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H1036-229 (HMO) plan covers vision services, including eye exams with a copay between $0 and $35. Eyewear is covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay. Other Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay, but fluoride treatment, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H1036-229 (HMO) plan, with prior authorization required. The plan's coinsurance for these services varies, and there is a $35 copay for Medicare Part B Insulin Drugs.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H1036-229 (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment includes Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment (DME) has a 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a $10 copay, and the other medical supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $150, and lab services with no copay. Radiological Services include coverage for diagnostic radiological services with a copay up to $300, therapeutic radiological services with a copay up to $15 and 20% coinsurance, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-229 (HMO) plan 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 covered, but the plan does not specify the copay or coinsurance. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H1036-229 (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $60 copay for days 21-100, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H1036-229 (HMO) plan covers acupuncture with no copay, but is limited to 25 treatments per year and requires prior authorization. Over-the-counter (OTC) items are covered with a maximum benefit of $50.00 every three months, and the plan offers Nicotine Replacement Therapy (NRT) and Naloxone coverage as a Part C OTC benefit. Other services such as meal benefits, and several additional services are not covered.
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