A non-government entity
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 $125.00. 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 $3300.00 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:
Sign up for Humana Gold Plus Giveback H1036-265 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus Giveback H1036-265 (HMO) plan has an Enhanced Alternative drug benefit. This plan has no deductible. In the initial coverage phase, you will pay no copay for preferred generic drugs at a preferred pharmacy, and a $20 copay at a standard mail pharmacy. For standard generic drugs, you will pay a $30 copay at a preferred pharmacy, and a $47 copay at a standard mail pharmacy. For preferred brand drugs, you will pay 35% coinsurance, regardless of pharmacy. 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 wide range of benefits with varying cost-sharing. Many services have no copay, including primary care visits, routine eye exams, and preventive services like an annual physical. You will pay a copay for services such as inpatient hospital stays, specialist visits, and hearing exams, with some services also requiring coinsurance. This plan covers essential services like hospital stays, outpatient services, and emergency care. It also includes coverage for vision, hearing, and dental services with no or low copays for many services. Transportation to health-related locations is available, as well as home health services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $170 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all 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 $205, observation services have a $170 copay, ASC services have no copay, individual and group substance abuse sessions have a copay between $30 and $100, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Air ambulance services have a 20% coinsurance, and ground ambulance services have a copay between $0 and $250. Transportation services to a plan-approved health-related location have no copay, and cover up to 24 one-way trips per year using a taxi, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Humana Gold Plus Giveback H1036-265 (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $15 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 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 $20 copay, and Occupational Therapy Services with a $30-$40 copay. Physician Specialist Services have a $30 copay, and Mental Health Specialty Services have a $30 copay for individual and group sessions. Podiatry Services and Routine Foot Care have a $30 copay, and Other Health Care Professional services have a $0-$30 copay. Psychiatric Services have a $30 copay for individual and group sessions, and Physical Therapy and Speech-Language Pathology Services have a $30-$40 copay. Additional Telehealth Benefits have a $0-$30 copay, and Opioid Treatment Program Services have a $30-$100 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, while additional preventive services are covered, but may have a copay. Kidney Disease Education Services, and other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
The Humana Gold Plus Giveback H1036-265 (HMO) plan covers hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $199 and $1299, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a copay of $0-$30, and routine eye exams have no copay. Eyewear includes contact lenses and eyeglasses (lenses and frames) with no copay, and a combined maximum plan benefit of $300 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus Giveback H1036-265 (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Restorative services have a $25 copay, and adjunctive general services have no copay. Fluoride treatment, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance applies between 0% and 20%.
Dialysis Services See details
Dialysis services are covered, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable medical equipment has a 20% coinsurance, and no copay, while durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have no copay. Diabetic supplies have a 20% coinsurance and no copay, while diabetic therapeutic shoes/inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay up to $175, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $205, and Therapeutic Radiological Services with a copay up to $30 and 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 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 covered by Humana Gold Plus Giveback H1036-265 (HMO), but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for this benefit.
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; additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus Giveback H1036-265 (HMO) plan covers acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year. Other services such as over-the-counter items, meal benefits, and various other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved