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Humana Gold Plus H1036-230 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-230 (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 H1036-230 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-230 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Hardee, Highlands and Polk counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H1036-230 (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 H1036-230 (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 H1036-230 (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 $3.00. 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 $2400.00 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 H1036-230 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for one-month and three-month supplies when using standard pharmacies or preferred mail order. If you choose standard mail order, Tier 1 drugs have a $10 copay and Tier 2 drugs have a $15 copay for a one-month supply. Tier 3 preferred brand drugs require a $30 copay for a one-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. Tier 4 non-preferred drugs require a 45% coinsurance across all pharmacy and mail order options. For Tier 5 specialty tier drugs, you will pay a 25% coinsurance for a one-month supply.
Additional Benefits
The Humana Gold Plus H1036-230 (HMO) plan offers comprehensive medical coverage with low out-of-pocket costs, featuring no copays or coinsurance for primary care visits, preventive services, and home health care. For hospital stays, members pay a low $20 copay for the first three days of inpatient care and no copay for days four through ninety. Specialist visits, urgent care, and diagnostic lab services are also highly affordable, requiring no copays or minimal copays up to $30 with no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $1,500 annual limit and a $300 annual vision allowance, both with no copays or coinsurance. Additionally, members receive routine hearing exams with no copay, up to 50 free one-way transportation trips to approved locations, and no copay for the first 20 days in a skilled nursing facility. Other extra benefits include acupuncture treatments and over-the-counter item reimbursements with no copays or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H1036-230 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $20 copay for days 1 through 3 and no copay for days 4 through 90. Unlimited additional acute hospital days are covered with no copay, but additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H1036-230 (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services have a copay of $0 to $75, observation services cost a $20 copay per stay, and outpatient substance abuse sessions require a $5 to $30 copay, with prior authorization and referrals required for most services.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Gold Plus H1036-230 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-230 (HMO) covers ground ambulance services with a copay of $0 to $200 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation benefits are partially covered with no copay or coinsurance for up to 50 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H1036-230 (HMO) covers emergency services with a $150 copay and no coinsurance, and this copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-230 (HMO) covers primary care physician services with no copay and no coinsurance, while chiropractic services are not covered. Specialist visits, mental health, therapy, podiatry, telehealth, and opioid treatments are covered with copays ranging from $0 to $30 and no coinsurance.
Preventive Services See details
Humana Gold Plus H1036-230 (HMO) covers preventive services, including annual physicals, kidney disease education, and screenings, with no copay and no coinsurance. Additional preventive services are partially covered, providing fitness and in-home support with no copay and no coinsurance, while excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus H1036-230 (HMO) covers hearing services, including routine hearing exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance, plus Medicare-covered exams for a $5.00 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199.00 to $1,299.00 for up to two aids per year, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Gold Plus H1036-230 (HMO) partially covers vision services with no deductible and no coinsurance, offering one routine eye exam per year and contact lenses or eyeglasses (lenses and frames) with no copay under a $300 annual limit. Other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-230 (HMO) offers partially covered dental services with a $1,500 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive care including cleanings, exams, and oral surgery. Medicare-covered dental requires a $5 copay and no coinsurance, removable prosthodontics require a 30% coinsurance with no copay, and services such as fluoride, endodontics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H1036-230 (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1036-230 (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Humana Gold Plus H1036-230 (HMO) covers durable medical equipment and diabetic supplies with a 20% coinsurance and no copay, while prosthetic devices and medical supplies are covered with no copay and no coinsurance. Prior authorization is required for these medical equipment benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-230 (HMO) covers diagnostic and radiological services, requiring prior authorizations and referrals. Diagnostic procedures carry a $0 to $50 copay and lab services have no copay, both with no coinsurance. Diagnostic radiological services have a minimum $0 copay and no coinsurance, therapeutic radiological services require a minimum $5.00 copay and 20% coinsurance, and outpatient X-rays have no copay but require coinsurance.
Home Health Services See details
Humana Gold Plus H1036-230 (HMO) covers Home Health Services with no copay and no coinsurance. To access this benefit, both prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-230 (HMO) offers cardiac rehabilitation services with no coinsurance, but in practice some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-230 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, but does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $160 copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1036-230 (HMO) offers partial coverage for other services, as meal benefits are not covered. Covered benefits include acupuncture (up to 25 treatments per year with prior authorization required) and over-the-counter items via reimbursement, both of which feature no copay and no coinsurance.
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