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Humana Gold Plus Giveback H1036-269 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-269 (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 H1036-269 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-269 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Counties: LAK, MRN, ORA, OSC, SEM, SUM. 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 H1036-269 (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 H1036-269 (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 H1036-269 (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 $155.00. 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 $3200.00 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 H1036-269 (HMO) Medicare plan features a $0 drug deductible, allowing your prescription drug coverage to begin immediately. For Tier 1 preferred generics and Tier 2 generics, there is no copay for either a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Standard mail order for these generic tiers ranges from a $10 to $20 copay for a 1-month supply. Tier 3 preferred brand drugs have a $30 copay for a 1-month supply at standard pharmacies or via preferred mail order, while standard mail order costs $47. For more specialized medications, Tier 4 non-preferred drugs require a 35% coinsurance and Tier 5 specialty drugs carry a 33% coinsurance. These cost-sharing options make the plan highly competitive for individuals seeking affordable generic and brand-name prescription coverage.
Additional Benefits
The Humana Gold Plus Giveback H1036-269 (HMO) plan offers robust core medical coverage with predictable costs, including no copay and no coinsurance for primary care visits and preventive screenings. Inpatient hospital stays require a $135 daily copay for the first six days and no copay thereafter, while outpatient hospital services range from no copay to a $175 copay. Emergency care is accessible with a $150 copay, which is waived if you are admitted, and urgent care visits require a low $15 copay. This plan also includes valuable supplemental benefits, featuring no copay for routine vision and hearing exams, alongside a $400 annual eyewear allowance and up to $1,000 in covered dental services. Members can take advantage of up to 50 free one-way transportation trips per year to plan-approved locations and no copay for the first 20 days of a skilled nursing facility stay. Additionally, home health services and laboratory tests are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus Giveback H1036-269 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $135 daily copay for days 1 to 6 and no copay for remaining covered days. Prior authorization is required, and the benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H1036-269 (HMO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $175 (or $135 per stay for observation), while outpatient substance abuse sessions carry a copay of $10 to $35.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus Giveback H1036-269 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus Giveback H1036-269 (HMO) covers ground ambulance services with a copay of up to $240 and coinsurance, and air ambulance services with a 20% coinsurance and a copay. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus Giveback H1036-269 (HMO) covers emergency services with a $150 copay—waived if admitted to the hospital within 24 hours—and urgently needed services with a $15 copay, with no coinsurance for either. Worldwide emergency, urgent, and transportation services are also covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Giveback H1036-269 (HMO) covers primary care physician services with no copay and no coinsurance, though chiropractic services are not covered. Other covered services, including specialist visits, mental health, therapies, and podiatry, require copays ranging from $0 to $40 and no coinsurance.
Preventive Services See details
Preventive services are covered by Humana Gold Plus Giveback H1036-269 (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and other preventive screenings. Additional preventive services are partially covered, and sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy 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 devices, and counseling are not covered.
Hearing Services See details
Humana Gold Plus Giveback H1036-269 (HMO) covers Medicare-covered hearing exams with a $15 copay and routine exams or fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $199 to $1,299 and no coinsurance for up to two devices per year, but inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus Giveback H1036-269 (HMO), offering one routine eye exam per year with no copay, no coinsurance, and no deductible. Eyewear is also partially covered with no copay or coinsurance up to a $400 annual limit for one pair of contact lenses or complete eyeglasses, while upgrades, individual frames or lenses, and other eye exam services are not covered.
Dental Services See details
Humana Gold Plus Giveback H1036-269 (HMO) partially covers dental services up to a $1,000 annual limit, offering Medicare-covered dental for a $15 copay and no coinsurance, and most preventive and comprehensive services with no copay and no coinsurance. Removable prosthodontics require no copay and 30% coinsurance, while fluoride, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H1036-269 (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus Giveback H1036-269 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this benefit.
Medical Equipment See details
Humana Gold Plus Giveback H1036-269 (HMO) covers medical equipment, with prior authorization required for durable medical equipment (DME), prosthetics, and diabetic services. Members will pay a 20% coinsurance and no copay for DME, prosthetic devices, and diabetic supplies, while medical supplies and diabetic therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Humana Gold Plus Giveback H1036-269 (HMO) plan, with prior authorization and referrals required. There is no coinsurance and no copay for lab services, outpatient X-rays, and diagnostic radiological services, though diagnostic procedures and tests have a $0 to $100 copay, and therapeutic radiological services require a minimum $10 copay and 20% coinsurance.
Home Health Services See details
The Humana Gold Plus Giveback H1036-269 (HMO) plan 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 covered by Humana Gold Plus Giveback H1036-269 (HMO) with no coinsurance, requiring prior authorization and a referral. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered in practice.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H1036-269 (HMO) covers skilled nursing facility services with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 through 20, followed by a $160 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the Medicare limit are not covered.
Other Services See details
Humana Gold Plus Giveback H1036-269 (HMO) partially covers other services, offering 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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