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Humana Gold Plus Giveback H1036-266 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-266 (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 H1036-266 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-266 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Counties: CIT, HARD, HIG, PLK. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus Giveback H1036-266 (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 H1036-266 (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 H1036-266 (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 $116.00. 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 $3400.00 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 H1036-266 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy. For example, standard generic drugs have a $30 copay, while preferred brand drugs have 35% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus Giveback H1036-266 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, but many outpatient services, including primary care, have no copay. The plan also provides coverage for emergency services, ambulance services, and other services like hearing, vision, and dental. Diagnostic and radiological services, as well as home health and skilled nursing facilities, are covered, but may involve copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services; for days 1-6, there is a $100 copay, and for days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute have no copay for days 91-999, while 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 include coverage for all outpatient hospital services with a copay between $0 and $125, observation services with a $100 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a copay between $30 and $100 for both individual and group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus Giveback H1036-266 (HMO) plan. You will have a $45 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services and transportation to plan-approved health-related locations. Ground ambulance services have a copay between $0 and $250, while air ambulance services have a 20% coinsurance; transportation services to plan-approved health-related locations have no copay, with a limit of 50 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus Giveback H1036-266 (HMO) plan. 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; all services have no coinsurance.
Primary Care See details
The Humana Gold Plus Giveback H1036-266 (HMO) plan covers Primary Care Physician Services with no copay. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a copay between $35 and $40, and a referral and prior authorization are required. Physician Specialist Services have a $30 copay, and require prior authorization and a doctor referral. Mental Health Specialty Services and Psychiatric Services each have a $30 copay for individual and group sessions, and both require prior authorization and a doctor referral. Podiatry Services, Other Health Care Professional, Additional Telehealth Benefits, and Opioid Treatment Program Services also have copays, with details provided. Physical Therapy and Speech-Language Pathology Services have a copay between $35 and $40, and require a referral and prior authorization.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional services with a copay; however, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. This plan also covers Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $30 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay, each limited to 1 visit per year. Prescription hearing aids (all types) are covered with a copay between $199 and $1299 for 2 hearing aids every year, while inner ear, outer ear, and over the ear hearing aids are not covered; OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$30, and routine eye exams have no copay. Eyewear has no copay, and contact lenses and eyeglasses are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus Giveback H1036-266 (HMO) plan covers Medicare Dental Services with a $30 copay, and other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, periodontics, prosthodontics (removable), and oral and maxillofacial surgery, all with no copay. Fluoride treatment, endodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
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. The plan has a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 20% for all other covered services.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus Giveback H1036-266 (HMO) plan, with a coinsurance of 20% for all services. Prior authorization and a doctor referral are required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance for Medicare-covered medical supplies and a copay for Medicare-covered prosthetic devices. 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 all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests and lab services, and all radiological services, with a copay for Medicare-covered diagnostic and therapeutic radiological services, and X-ray services. Diagnostic Procedures/Tests have a copay between $0 and $180, and Lab Services have no copay. Therapeutic Radiological Services have a 20% coinsurance and a copay of at most $30, while Diagnostic Radiological Services have a copay of at most $125. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus Giveback H1036-266 (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization and a doctor referral are required to receive coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with prior authorization required. There is no copay for days 1-20, and a $150 copay for days 21-100, with no coinsurance.
Other Services See details
Other Services includes acupuncture with no copay, but is limited to 25 treatments per year and requires prior authorization. Over-the-counter items, meal benefits, 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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