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Humana Gold Plus Giveback H1036-278 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-278 (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 H1036-278 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-278 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Gulf Coast. 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 H1036-278 (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 H1036-278 (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 H1036-278 (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 $80.00. 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 $4400.00 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 H1036-278 (HMO) Medicare plan offers prescription drug coverage with a $0 drug deductible, meaning your benefits start immediately. Beneficiaries pay no copay for Tier 1 preferred generic and Tier 2 generic medications when filled as a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Standard mail order options for these generic tiers are also affordable, with 1-month copays starting at $10 for Tier 1 and $20 for Tier 2. For Tier 3 preferred brand drugs, you will pay a $30 copay for a 1-month supply at standard pharmacies and preferred mail order. Tier 4 non-preferred drugs require a 35% coinsurance, while Tier 5 specialty tier medications carry a 33% coinsurance for a 1-month supply across standard pharmacies and all mail order options.
Additional Benefits
The Humana Gold Plus Giveback H1036-278 (HMO) plan offers affordable healthcare coverage with no copay or coinsurance for primary care visits, home health services, and annual preventive screenings. Specialist visits require a $35 copay, while inpatient hospital stays have a $200 daily copay for the first several days and no copay for subsequent days. Emergency room visits are covered with a $130 copay, which is waived if you are admitted within 24 hours. Routine vision and hearing exams are covered with no copay, and dental services feature no copay for preventive care alongside a $25 copay for restorative treatments up to a $1,000 annual limit. Select eyewear is covered up to $200 annually, while prescription hearing aids require copays ranging from $399 to $1,299. For medical equipment and dialysis services, members will pay a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Plus Giveback H1036-278 (HMO) covers inpatient hospital services with no coinsurance, requiring a $200 daily copay for days 1 to 7 for acute stays and days 1 to 6 for psychiatric stays, with no copay for subsequent days. Prior authorization is required, and specific sub-services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H1036-278 (HMO) covers outpatient services with no coinsurance, including a $0 to $220 copay for outpatient hospital services and a $200 copay per stay for observation services. Outpatient substance abuse sessions have a $35 copay, while ambulatory surgical center and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Humana Gold Plus Giveback H1036-278 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus Giveback H1036-278 (HMO) covers ground ambulance services with prior authorization for a copay of no copay to $240 along with coinsurance, while air ambulance services require a 20% coinsurance and a copay. Transportation services are not covered under this plan.
Emergency Services See details
Humana Gold Plus Giveback H1036-278 (HMO) covers emergency services with a $130 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 covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Giveback H1036-278 (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Other covered services, including physical therapy, mental health, and podiatry, feature copays ranging from no copay up to $40 with no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Humana Gold Plus Giveback H1036-278 (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and various screenings. Additional preventive benefits are partially covered with no copay or coinsurance and require prior authorization, but do not cover health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety devices, or counseling services.
Hearing Services See details
Humana Gold Plus Giveback H1036-278 (HMO) covers Medicare-covered hearing exams with a $35 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $399 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 Humana Gold Plus Giveback H1036-278 (HMO), featuring no deductibles, no coinsurance, and no copay for one routine eye exam per year and select eyewear up to a $200 annual limit. Covered eyewear includes contact lenses and eyeglasses (lenses and frames), while other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services for Humana Gold Plus Giveback H1036-278 (HMO) are partially covered up to a $1,000 annual limit, offering preventive and diagnostic care with no copay and no coinsurance, and restorative or periodontic services for a $25 copay and no coinsurance. Medicare-covered dental services require a $35 copay and no coinsurance, while fluoride, endodontics, prosthodontics, 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 H1036-278 (HMO) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Humana Gold Plus Giveback H1036-278 (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 H1036-278 (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus Giveback H1036-278 (HMO) covers diagnostic and radiological services, which require prior authorization and referrals. Diagnostic tests range from a $0 to $200 copay with no coinsurance, lab services and diagnostic radiology have no copay, and therapeutic radiology requires a minimum 20% coinsurance and $35 copay.
Home Health Services See details
Humana Gold Plus Giveback H1036-278 (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 H1036-278 (HMO) with no coinsurance, though only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H1036-278 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $160 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus Giveback H1036-278 (HMO) partially covers other services, offering acupuncture with no copay and no coinsurance for up to 25 treatments per year with prior authorization. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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