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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 2025, 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 out of 5 stars in 2025.
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 $150.00. 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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. You will enter the next coverage phase once your total drug costs reach $2,000. In the catastrophic coverage phase, you pay nothing for covered Part D drugs after your yearly out-of-pocket costs reach $2,000. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Humana Gold Plus Giveback H1036-269 (HMO) plan offers a wide range of benefits with varying costs. You'll find coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $175. Emergency, urgent, and primary care services are covered, with copays between $0 and $140. Additional benefits include coverage for hearing, vision, and dental services, with copays and coinsurance depending on the service. The plan also covers home health, skilled nursing, and ambulance services, with copays and coinsurance varying by service. Some services, like dialysis and cardiac rehabilitation, require prior authorization.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered, with a $150 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $175, Observation Services with a $150 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $10 and $75 for both individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $45 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground ambulance services with a copay between $0 and $260, and air ambulance services with 20% coinsurance. Transportation Services to a plan-approved health-related location is covered with no copay for up to 50 one-way trips per year. Transportation Services to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus Giveback H1036-269 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $15 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus Giveback H1036-269 (HMO) plan covers Primary Care Physician Services with no copay. Chiropractic Services have a $10 copay. Occupational Therapy Services have a copay between $15 and $40, and Physical Therapy and Speech-Language Pathology Services have a copay between $15 and $40. Physician Specialist Services and Mental Health Specialty Services have a $10 copay, and Podiatry Services have a $10 copay. Other Health Care Professional services have a copay between $0 and $10. Psychiatric Services have a $10 copay. The plan also covers Additional Telehealth Benefits with a copay between $0 and $15, and Opioid Treatment Program Services with a copay between $10 and $75.
Preventive Services See details
The Humana Gold Plus Giveback H1036-269 (HMO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, kidney disease education services, and other preventive services, all with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $10 copay, routine hearing exams with no copay for 1 visit per year, and fitting/evaluation for hearing aids with no copay for 1 visit per year. Prescription hearing aids are covered with a copay between $199 and $1299 for 2 visits per year, 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
The Humana Gold Plus Giveback H1036-269 (HMO) plan covers vision services, including routine eye exams with a copay of $0 - $10. Eyewear is covered, including contact lenses and eyeglasses with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $10 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, periodontics, prosthodontics (removable) with a 30% coinsurance, and oral and maxillofacial surgery with no copay. Fluoride treatment, endodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. The plan has a maximum benefit of $1,000 per year for other dental services.
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. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Plus Giveback H1036-269 (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, while 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 are covered. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $175, Therapeutic Radiological Services have a copay of at most $25 and a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus Giveback H1036-269 (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, but the plan does not cover any specific services such as Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a $0 copay for days 1-20 and a $160 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year. 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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