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Humana Gold Plus H1036-233 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-233 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H1036-233 (HMO-POS) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-233 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Raleigh Metro Area. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H1036-233 (HMO-POS) 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 H1036-233 (HMO-POS).
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 H1036-233 (HMO-POS), 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 $350.00 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 $9250.00 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 H1036-233 (HMO-POS) prescription drug plan features an annual drug deductible of $350. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and preferred mail-order services. Tier 2 generic medications cost as low as a $5 copay for a 1-month supply, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a copay of $47 for a 1-month supply across standard pharmacies and mail-order options. Higher-tier medications carry coinsurance costs, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus H1036-233 (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care physician visits and a $20 copay for specialists. Emergency services are covered with a $115 copay, while inpatient acute hospital stays require a $375 daily copay for the first seven days and no copay thereafter. Outpatient services and diagnostic lab tests are also highly accessible, with many services requiring no copay and no coinsurance. Supplemental benefits include preventive dental care and routine eye exams with no copay, helping members manage their out-of-pocket costs. The plan covers dental services up to a $1,500 yearly maximum and provides a $400 annual allowance for eyewear with no copay. Additionally, routine hearing exams and home health services are covered with no copay, though prescription hearing aids and medical equipment require varying copays or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H1036-233 (HMO-POS) covers inpatient acute hospital stays with no coinsurance, requiring a $375 daily copay for days 1 to 7 and no copay for days 8 and beyond. Inpatient psychiatric care is also covered with no coinsurance at a $375 daily copay for days 1 to 5, though prior authorization is required for both benefits, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H1036-233 (HMO-POS) covers outpatient hospital services with no coinsurance and a copay ranging from $0 to $450, alongside observation services with no coinsurance and a $375 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H1036-233 (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-233 (HMO-POS) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization requirements. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H1036-233 (HMO-POS) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-233 (HMO-POS) features primary care physician services with no copay and no coinsurance, and specialist visits for a $20 copay and no coinsurance. Physical, occupational, and speech therapies require a $25 copay and no coinsurance, while mental health and psychiatric services have a $35 copay and no coinsurance. Telehealth benefits are available with a $0 to $40 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H1036-233 (HMO-POS) preventive services are partially covered with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, glaucoma screenings, diabetes training, and memory fitness. Supplemental services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus H1036-233 (HMO-POS) partially covers hearing services, excluding OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids. Medicare-covered exams require a $20 copay and no coinsurance, while routine annual exams and fitting evaluations have no copay and no coinsurance. Covered prescription hearing aids are limited to two per year with no coinsurance and copays ranging from $199 to $799.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H1036-233 (HMO-POS) with no coinsurance, no deductibles, and prior authorization required. Routine eye exams and eyewear, including one pair of contact lenses or eyeglasses per year, are covered with no copay up to a $400 annual limit, while other eye exams, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-233 (HMO-POS) dental services are partially covered up to a $1,500 yearly maximum, offering Medicare-covered dental care for a $20 copay and no coinsurance. Preventive and comprehensive dental services are available with no copay and no coinsurance, though fluoride treatments, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-233 (HMO-POS) covers Home Infusion bundled Services with no copay, subject to prior authorization. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H1036-233 (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Humana Gold Plus H1036-233 (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-233 (HMO-POS) covers diagnostic and radiological services with no copay for lab services and outpatient X-rays. Diagnostic procedures and tests carry a copay ranging from $0 to $120 with no coinsurance, while therapeutic radiological services require a minimum 20% coinsurance and a $20 minimum copay.
Home Health Services See details
Humana Gold Plus H1036-233 (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-233 (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance and requires prior authorization, although some services are covered while standard cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $30 copay), pulmonary rehabilitation (with a $25 copay), and SET for PAD services (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-233 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Humana Gold Plus H1036-233 (HMO-POS) provides partial coverage for other services, including acupuncture for a $20 copay and no coinsurance up to 20 treatments per year, and meal benefits for chronic illnesses with no copay or coinsurance. Prior authorization is required for both covered services, while over-the-counter (OTC) items are not covered under this benefit.
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