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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 2025, 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 out of 5 stars in 2025.
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 $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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy and a $15 copay at a standard mail pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your drug costs may be further reduced.
Additional Benefits
The Humana Gold Plus H1036-230 (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $35 copay for the first three days, while outpatient services have copays ranging from $0 to $60. Emergency and urgent care services have a $140 copay, while primary care visits have no copay. This plan includes coverage for preventive services and offers no copay for routine eye exams, and offers eyewear with a combined maximum of $300 per year. Dental services like oral exams and cleanings have no copay, and hearing exams have a $5 copay. Additionally, the plan covers home health services, and skilled nursing facilities, as well as other services like acupuncture and OTC items with specific copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $35 copay for days 1-3, and no copay for days 4-90, with no coinsurance; additional days 91-999 have no copay. Inpatient Hospital Psychiatric has the same cost sharing as Inpatient Hospital-Acute. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $60, Observation Services have a $35 copay, Ambulatory Surgical Center Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a copay between $5 and $30.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H1036-230 (HMO) plan, and requires prior authorization. You will have a $25 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, as well as transportation to plan-approved health-related locations. Ground ambulance services have a copay of $0-$215, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations have no copay, and are limited to 50 one-way trips per year. 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, Urgent Coverage, and Transportation each have a $140 copay, while Urgently Needed Services has a $5 copay; there is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus H1036-230 (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $5 copay, but routine care is not covered. Occupational Therapy Services, Physician Specialist Services, and Mental Health Specialty Services have a $5 copay. Podiatry Services and Routine Foot Care have a $5 copay. Other Health Care Professional services have a $0 - $5 copay, and Physical Therapy and Speech-Language Pathology Services have a $5 - $20 copay. Additional Telehealth benefits have a $0 - $5 copay, and Opioid Treatment Program Services have a $5 - $30 copay.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and additional preventive services with a copay that varies depending on the service. Other services like health education, home safety assessments, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $5 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are partially covered, but Inner Ear, Outer Ear, and Over the Ear prescription hearing aids are not covered. OTC hearing aids are covered up to $100 every three months.
Vision Services See details
The Humana Gold Plus H1036-230 (HMO) plan covers vision services, including routine eye exams with no copay, and eyewear with no copay up to a $300 combined maximum per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H1036-230 (HMO) plan covers a range of dental services, including oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services, with no copay for these services. The plan also covers Prosthodontics, removable services with a 30% coinsurance and no copay. However, fluoride treatment, endodontics, maxillofacial prosthetics, implant services, prosthodontics fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. There is a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 20% depending on the drug, and a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1036-230 (HMO) plan, and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by Humana Gold Plus H1036-230 (HMO). DME has a 20% coinsurance and no copay, while Diabetic Supplies have a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Humana Gold Plus H1036-230 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay; Diagnostic Radiological Services have a copay up to $60.00, and Therapeutic Radiological Services have a copay up to $5.00 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay, and all services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-230 (HMO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H1036-230 (HMO). There is no copay for days 1-20, and a $150 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year, and over-the-counter (OTC) items, with a maximum benefit of $100 every three months, and includes nicotine replacement therapy. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more, are not covered.
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