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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 2026, 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 4.5 out of 5 stars in 2026.
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 $165.50. 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 features a $0 prescription drug deductible, meaning your coverage begins immediately with no upfront out-of-pocket costs. For Tier 1 preferred generics and Tier 2 generics, there is no copay for one-month or three-month supplies when filled at standard retail pharmacies or through preferred mail order. If you choose standard mail order, copays for these generic tiers range from $10 to $20 for a one-month supply. For Tier 3 preferred brand drugs, you will pay a $30 copay for a one-month supply at standard pharmacies and preferred mail order. Tier 4 non-preferred drugs require a 35% coinsurance across all pharmacy and mail order channels. Specialty medications in Tier 5 carry a 33% coinsurance for a one-month supply, ensuring you only pay a set percentage of the drug cost.
Additional Benefits
The Humana Gold Plus Giveback H1036-265 (HMO) plan offers affordable healthcare coverage, featuring no copay and no coinsurance for primary care physician visits, annual physicals, and home health services. Specialist visits require a $10 copay, and emergency room visits carry a $150 copay which is waived if you are admitted within 24 hours. For inpatient hospital stays, members pay a $125 daily copay for days one through four, with no copay for days five through ninety. To support your overall well-being, the plan also covers routine dental, vision, and hearing exams with no copay and no coinsurance. Dental services are covered up to a $1,250 annual maximum, and eyewear is covered up to a $300 annual limit. Additionally, members can access up to fifty one-way trips per year to plan-approved locations with no copay and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus Giveback H1036-265 (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $125 daily copay for days 1 to 4 and no copay for days 5 to 90 for both acute and psychiatric stays. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H1036-265 (HMO) covers outpatient services with no coinsurance, including outpatient hospital visits with copays ranging from $0 to $175 and observation services with a $125 copay per stay. There is no copay for ambulatory surgical center or outpatient blood services, and outpatient substance abuse sessions range from no copay to a $10 copay, with prior authorization and referrals required for most services.
Partial Hospitalization See details
Humana Gold Plus Giveback H1036-265 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Humana Gold Plus Giveback H1036-265 (HMO) with prior authorization, requiring a $0 to $240 copay and coinsurance for ground transport, and 20% coinsurance plus a copay for air transport. Transportation is partially covered, offering up to 50 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus Giveback H1036-265 (HMO) covers emergency services with a $150 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 $15 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 Giveback H1036-265 (HMO) primary care benefits feature no copay and no coinsurance for primary care physician services, and a $10 copay with no coinsurance for specialist visits. Physical, occupational, and speech therapy services require a $15 to $30 copay with no coinsurance, while routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by Humana Gold Plus Giveback H1036-265 (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, diabetes training, glaucoma screenings, fitness benefits, and in-home support. This benefit is partially covered, as sub-services like health education, PERS, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus Giveback H1036-265 (HMO) partially covers hearing services, with exclusions for OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids. Routine exams and fitting evaluations are available with no copay and no coinsurance, while Medicare-covered exams carry a $10 copay and no coinsurance. Covered prescription hearing aids have no coinsurance and require a copay ranging from $199.00 to $1299.00.
Vision Services See details
Humana Gold Plus Giveback H1036-265 (HMO) offers partially covered vision services with no copay and no coinsurance for one routine eye exam per year and qualifying eyewear. Covered eyewear, including contact lenses and eyeglasses (lenses and frames), has a $300 annual maximum limit with no deductible, while other eye exams, separate lenses or frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Giveback H1036-265 (HMO) partially covers dental services up to a $1,250 annual maximum, offering no copay and no coinsurance for preventive care and most comprehensive services, a 30% coinsurance with no copay for prosthodontics, and a $10 copay with no coinsurance for Medicare-covered dental. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H1036-265 (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Part B insulin carries a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus Giveback H1036-265 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
Humana Gold Plus Giveback H1036-265 (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. Durable medical equipment and diabetic supplies require a 20% coinsurance and no copay, prosthetic devices require a 20% coinsurance, and medical supplies and diabetic shoes are covered with no copay.
Diagnostic and Radiological Services See details
Humana Gold Plus Giveback H1036-265 (HMO) covers diagnostic and radiological services, with prior authorization and referrals required. Diagnostic procedures carry a $0 to $110 copay and no coinsurance, while lab services and outpatient X-rays have no copay. Therapeutic radiological services require a minimum 20% coinsurance and a $10 copay.
Home Health Services See details
Humana Gold Plus Giveback H1036-265 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus Giveback H1036-265 (HMO) plan. This means there is no coverage for cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus Giveback H1036-265 (HMO) with no coinsurance and do not require a prior three-day inpatient hospital stay, although prior authorization is required. You will pay no copay for days 1 through 20 and a $160 daily copay for days 21 through 100, with no coverage available for additional days beyond the standard Medicare-covered limit.
Other Services See details
Humana Gold Plus Giveback H1036-265 (HMO) partially covers other services, offering acupuncture with no copay and no coinsurance for up to 25 treatments per year with prior authorization. Over-the-Counter (OTC) items and meal benefits are not covered under this plan.
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