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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 2025, 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 out of 5 stars in 2025.
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 $9350.00 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) plan has a $350 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For drugs in the Initial Coverage Phase, you will pay a $5 copay for preferred generic drugs at preferred and mail-order pharmacies, and a $20 copay at standard pharmacies. Standard generic drugs have a $47 copay, and preferred brand drugs have a 43% coinsurance. Non-preferred drugs have 28% coinsurance. Once your total drug costs reach $2000, you enter the Catastrophic Coverage Phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H1036-233 (HMO-POS) plan offers a range of health benefits, including inpatient and outpatient hospital services, with varying copays. You can expect no copay for primary care, preventive services, and home health services. The plan also includes coverage for hearing, vision, and dental services, with copays depending on the specific service. Additionally, this plan covers ambulance, emergency, and transportation services, with copays applying. Other services like partial hospitalization, skilled nursing facility, and home infusion are also covered, but may require prior authorization or have associated copays and coinsurance. Be aware that some services like cardiac rehabilitation and certain dental procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a $399 copay for days 1-6, and no copay for days 7-90; additional days have no copay. For Inpatient Hospital Psychiatric, you will pay a $399 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays, upgrades, and additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Humana Gold Plus H1036-233 (HMO-POS) plan. Outpatient hospital services have a copay between $0 and $450, observation services have a $399 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services are covered with a copay between $45 and $100 for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H1036-233 (HMO-POS) plan with an $80 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a $315 copay, with no coinsurance. 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 by the Humana Gold Plus H1036-233 (HMO-POS) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus H1036-233 (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, but routine care is not covered. Occupational therapy services have a $25 copay. Physician specialist services have a $35 copay. Mental health specialty services, including individual and group sessions, have a $45 copay. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay between $0 and $45. Opioid treatment program services have a copay between $45 and $100.
Preventive Services See details
The Humana Gold Plus H1036-233 (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. The plan also covers other preventive services like glaucoma screening, diabetes self-management training, and more, all with no copay.
Hearing Services See details
Humana Gold Plus H1036-233 (HMO-POS) covers hearing exams with a $35 copay, and routine hearing exams with no copay for one visit every year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $499 and $799 for 2 visits every year; however, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, and eyewear with a $0 copay. Contact lenses and eyeglasses (lenses and frames) are covered, with a combined maximum benefit of $250 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $35 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery with no copay. This plan does not cover Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics. There is a $1,000 maximum benefit per year for Other Dental Services.
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. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0-20%, while the other drugs have coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H1036-233 (HMO-POS) plan, but require prior authorization. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment and Prosthetics/Medical Supplies, is covered by the Humana Gold Plus H1036-233 (HMO-POS) plan. Durable Medical Equipment has a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus H1036-233 (HMO-POS) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $120, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325, and Therapeutic Radiological Services have a maximum copay of $35 with a minimum coinsurance of 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-233 (HMO-POS) 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 not covered by the Humana Gold Plus H1036-233 (HMO-POS) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H1036-233 (HMO-POS) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100, but additional days beyond Medicare and non-Medicare stays are not covered. Prior authorization is required.
Other Services See details
For the Humana Gold Plus H1036-233 (HMO-POS) plan, Other Services includes acupuncture with a $35 copay and a limit of 20 treatments per year, and a meal benefit with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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