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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 $125.50. 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 $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:
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Drug Coverage
The Humana Gold Plus Giveback H1036-265 (HMO) plan features a $0 prescription drug deductible, providing immediate coverage for your medications. Beneficiaries pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a standard pharmacy or preferred mail order. Standard mail order for these generic tiers requires a copay ranging from $10 to $20 for a one-month supply. Tier 3 preferred brand drugs cost a $30 copay for a one-month supply at standard pharmacies and preferred mail order, or a $47 copay through standard mail order. Higher-tier medications are covered via coinsurance, with Tier 4 non-preferred drugs requiring a 35% coinsurance and Tier 5 specialty drugs requiring a 33% coinsurance.
Additional Benefits
The Humana Gold Plus Giveback H1036-265 (HMO) plan offers comprehensive medical coverage featuring no copays for primary care visits, routine preventive screenings, and home health services. For inpatient hospital stays, members pay a daily copay of $170 for the first seven days and no copay for days eight through 90, with no coinsurance. Specialist visits and urgent care require low copays, while emergency care is covered with a $150 copay that is waived upon hospital admission. This plan also includes valuable supplemental benefits, such as dental coverage up to $1,000 annually with no copay for preventive care, and vision coverage featuring a $300 annual allowance for eyewear with no copay. Routine hearing exams are provided with no copay, and members can access up to 24 one-way transportation trips to plan-approved locations with no copay. For specialized care like dialysis and durable medical equipment, members are responsible for a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus Giveback H1036-265 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $170 daily copay for days 1 through 7 and no copay for days 8 through 90. 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 no copay for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $205 copay, observation services carry a $170 copay per stay, and outpatient substance abuse sessions have a $30 to $35 copay, with prior authorization and referrals required for most treatments.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Gold Plus Giveback H1036-265 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Humana Gold Plus Giveback H1036-265 (HMO) plan, featuring a $0 to $240 copay plus coinsurance for ground ambulance and a 20% coinsurance plus a copay for air ambulance. Transportation is partially covered, providing up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services under the Humana Gold Plus Giveback H1036-265 (HMO) are covered with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed care is covered with a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Giveback H1036-265 (HMO) features primary care physician visits with no copay and no coinsurance, while chiropractic services are not covered. Other covered services, including specialist visits, therapies, and mental health, require copays of $30 to $40 and no coinsurance, with telehealth options ranging from no copay to a $30 copay and no coinsurance.
Preventive Services See details
Humana Gold Plus Giveback H1036-265 (HMO) covers essential preventive services, including annual physical exams, kidney disease education, and select screenings, with no copays and no coinsurance. While supplemental benefits like fitness and in-home support are covered with no copay, other services such as health education, nutritional therapy, and personal emergency response systems are not covered.
Hearing Services See details
Humana Gold Plus Giveback H1036-265 (HMO) covers hearing services with no deductible, offering Medicare-covered exams for a $30 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199 to $1,299, but OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by the Humana Gold Plus Giveback H1036-265 (HMO) plan, offering eye exams with no coinsurance and a $0 to $30 copay, which includes one routine exam per year with no copay. Covered eyewear, such as contact lenses and eyeglasses (lenses and frames), features no copay and no coinsurance up to a $300 annual limit, though individual eyeglass lenses, eyeglass frames, upgrades, and other eye exams are not covered.
Dental Services See details
Humana Gold Plus Giveback H1036-265 (HMO) offers partial dental coverage with up to a $1,000 annual limit, featuring no copay and no coinsurance for preventive services, a $25 copay and no coinsurance for restorative services, and a $30 copay and no coinsurance for Medicare-covered dental. Fluoride treatments, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus Giveback H1036-265 (HMO) with no copay and no coinsurance, though prior authorization and step therapy may apply. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Plus Giveback H1036-265 (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Humana Gold Plus Giveback H1036-265 (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with prior authorization required. For these covered benefits, you will pay a 20% coinsurance and no copay for DME, prosthetics, and diabetic supplies, and no copay for medical supplies and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Humana Gold Plus Giveback H1036-265 (HMO) covers diagnostic and radiological services, with prior authorization and referrals required. Lab services, outpatient X-rays, and diagnostic radiology feature no copay, while diagnostic tests range from no copay up to $175 with no coinsurance, and therapeutic radiology requires a minimum $25 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus Giveback H1036-265 (HMO) with no copay and no coinsurance. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus Giveback H1036-265 (HMO) indicates some services are covered with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Prior authorization and referrals are required for covered care.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H1036-265 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no copay for days 1 through 20, followed by a $160 daily copay for days 21 through 100. Prior authorization is required, although a prior three-day inpatient hospital stay is not, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus Giveback H1036-265 (HMO) partially covers other services, providing acupuncture with no copay and no coinsurance for up to 25 treatments per year, subject to prior authorization. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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