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Humana Gold Plus Giveback H1036-270 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-270 (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 H1036-270 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-270 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Jacksonville Metro area. 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 H1036-270 (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 H1036-270 (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 H1036-270 (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 $100.00. 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 $3900.00 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 H1036-270 (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no upfront costs. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. If you choose standard mail order for these lower-tier drugs, 1-month copays are $10 for Tier 1 and $20 for Tier 2. For higher-tier medications, Tier 3 preferred brand drugs require a $30 copay for a 1-month supply at standard pharmacies and preferred mail order. Tier 4 non-preferred drugs have a 35% coinsurance, and Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply across all available pharmacy and mail order channels. This structured pricing helps you easily plan your healthcare budget based on your specific prescription needs.
Additional Benefits
The Humana Gold Plus Giveback H1036-270 (HMO) plan offers comprehensive coverage with no copays for primary care visits, routine preventive services, lab tests, and home health care. For specialist visits, members pay a $25 copay, while inpatient hospital stays require a $195 copay for days one through five and no copay for days six through 90. Emergency care is accessible with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. Additional benefits include vision care with no copay for routine exams and up to $400 for eyewear, alongside dental coverage up to a $1,000 annual limit with no copay for most preventive services. Hearing care features no copay for routine exams and fitting evaluations, with hearing aid copays ranging from $199 to $1,299. For specialized medical needs, durable medical equipment and dialysis services carry a 20% coinsurance, while skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Gold Plus Giveback H1036-270 (HMO) with no coinsurance, requiring a $195 copay for days 1 to 5 and no copay for days 6 to 90. Unlimited additional acute care 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 H1036-270 (HMO) covers outpatient services with no coinsurance, featuring a copay of $0 to $195 for outpatient hospital services and $195 per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $25 to $35 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Gold Plus Giveback H1036-270 (HMO) with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus Giveback H1036-270 (HMO), with prior authorization required for all services. Ground ambulance services require a copay of $0 to $240 plus coinsurance, while air ambulance services require a 20% coinsurance plus a copay. Transportation is partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Humana Gold Plus Giveback H1036-270 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits under the Humana Gold Plus Giveback H1036-270 (HMO) plan feature no copay and no coinsurance for primary care visits, and a $25 copay with no coinsurance for specialist visits. Physical, occupational, and speech therapies require a $5 to $40 copay and no coinsurance, while some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus Giveback H1036-270 (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional supplemental preventive benefits are partially covered, offering memory fitness, smoking cessation counseling, and in-home support with no copay and no coinsurance, while health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Humana Gold Plus Giveback H1036-270 (HMO), featuring Medicare-covered exams for a $25 copay and no coinsurance, as well as 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 for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus Giveback H1036-270 (HMO) with no deductible and no coinsurance, though prior authorization and referrals are required. There is no copay for annual routine eye exams and covered eyewear—including contact lenses or eyeglasses up to a $400 annual limit—while other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Giveback H1036-270 (HMO) partially covers dental services up to a $1,000 annual limit, offering most preventive and comprehensive care with no copay and no coinsurance, while Medicare-covered dental requires a $25 copay (no coinsurance) and removable prosthodontics require a 30% coinsurance (no copay). Fluoride treatments, endodontics, implant services, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus Giveback H1036-270 (HMO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus Giveback H1036-270 (HMO) covers Dialysis Services 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 H1036-270 (HMO) covers medical equipment with prior authorization, requiring a 20% coinsurance and no copay for durable medical equipment (DME) and diabetic supplies. Prosthetic devices carry a 20% coinsurance, while medical supplies and diabetic therapeutic shoes are covered with no copay.
Diagnostic and Radiological Services See details
Humana Gold Plus Giveback H1036-270 (HMO) covers diagnostic and radiological services with no coinsurance, requiring referrals and prior authorization. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests range from a $0 to $195 copay, and therapeutic radiological services require a minimum copay of $25.
Home Health Services See details
Humana Gold Plus Giveback H1036-270 (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus Giveback H1036-270 (HMO) with no copay and no coinsurance, although prior authorization and referrals are required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H1036-270 (HMO) covers skilled nursing facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $160 daily copay for days 21 through 100. Prior authorization is required, no prior three-day inpatient hospital stay is needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus Giveback H1036-270 (HMO) provides partial coverage for other services, offering acupuncture for up to 25 treatments per year and meal benefits for chronic illnesses with no copay and no coinsurance. Over-the-counter (OTC) items are not covered, and prior authorization is required for the covered benefits.
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