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Humana Gold Plus Giveback H1036-265 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-265 (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 Giveback H1036-265 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-265 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Greater Tampa Bay. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus Giveback H1036-265 (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 Giveback H1036-265 (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 Giveback H1036-265 (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 $165.00. 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 Giveback H1036-265 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, you'll have no copay for preferred generic drugs at a standard pharmacy or preferred mail order. However, you will pay 35% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus Giveback H1036-265 (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services. You'll find no copays for many services, such as primary care, preventive services, and home health. This plan also provides coverage for hearing, vision, and dental services, with copays and coinsurance varying by service. Additionally, the plan covers ambulance and transportation services, as well as home infusion, dialysis, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-4 of Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays, there is a $125 copay, and for days 5-90, there is no copay. Additional days for Inpatient Hospital-Acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $175, observation services have a $125 copay, ASC services have no copay, individual and group outpatient substance abuse sessions have a copay between $0 and $10, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a copay between $0 and $200, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location have no copay, and the plan covers up to 50 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $140 copay, while Urgently Needed Services has a $15 copay.
Primary Care See details
The Humana Gold Plus Giveback H1036-265 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $10 copay, occupational therapy services with a copay between $15 and $30, and physician specialist services with a $10 copay. Mental health specialty services, including individual and group sessions, have a $10 copay. Podiatry services, including routine foot care, and psychiatric services, including individual and group sessions, also have a $10 copay. Physical therapy and speech-language pathology services have a copay between $15 and $30, and additional telehealth benefits range from no copay to a $15 copay. Opioid Treatment Program Services have a copay from $0 to $10.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services. Annual physical exams have no copay, while additional preventive services may have a copay. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $10 copay, as are routine hearing exams and fitting/evaluation for hearing aids, which have no copay. Prescription hearing aids are covered, with a copay between $199 and $1299, while 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 are covered, including eye exams and eyewear. Eye exams have a copay of $0-$10, and routine eye exams have no copay. Eyewear has no copay, and the plan provides a combined maximum of $300 per year for eyewear.
Dental Services See details
Dental Services are covered, with a yearly maximum of $1250. Medicare dental services have a $10 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery have no copay. Prosthodontics (removable and fixed) have a 30% coinsurance, and fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus Giveback H1036-265 (HMO) plan. The coinsurance for this service is 20%, with both a minimum and maximum coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus Giveback H1036-265 (HMO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices also have a 20% coinsurance. Medical Supplies have no copay, and Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $110, and lab services with no copay. Radiological services are covered with a copay of up to $175 for diagnostic services, up to a 20% coinsurance and a copay of up to $25 for therapeutic services, and no copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus Giveback H1036-265 (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 not covered by the Humana Gold Plus Giveback H1036-265 (HMO) plan. Prior authorization and a doctor's referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20, and a $150 copay for days 21-100.
Other Services See details
Other Services includes acupuncture with a $0 copay, but is limited to 25 treatments per year and requires prior authorization. Over-the-Counter (OTC) Items, Meal Benefit, 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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