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Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Gulf Coast. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP).
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 SNP-DE H1036-285 (HMO D-SNP), 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 a $320.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 SNP-DE H1036-285 (HMO D-SNP) plan has a $320 deductible. After the deductible is met, you will pay a copay or coinsurance for your prescriptions. For example, for a standard pharmacy, you'll pay no copay for preferred generic drugs, 25% coinsurance for standard generic, preferred brand, and non-preferred drugs. For mail order prescriptions, you'll pay a $20 copay for preferred generic drugs and 25% coinsurance for all other tiers. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) plan offers comprehensive coverage with a focus on low-cost care. Many services, including inpatient and outpatient hospital care, primary care, preventive services, hearing and vision exams, dental services, and home health services, come with no copay. Emergency services, ambulance services, and prescription hearing aids have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay. Additional Days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center Services, and Outpatient Blood Services have no copay, while Individual and Group Sessions for Outpatient Substance Abuse have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) plan, with no copay required. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a copay between $0 and $100, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, and include up to 50 one-way trips per year via taxi, bus/subway, or medical transport. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Urgently Needed Services has no copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $90 copay.
Primary Care See details
The Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, additional telehealth benefits, and opioid treatment program services have no copay. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services have a $0 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional preventive services, including wigs for hair loss related to chemotherapy, in-home support services, additional sessions of smoking and tobacco cessation counseling, and fitness benefits, all with no copay. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are also covered with no copay. Health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, support for caregivers of enrollees, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with no copay and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a maximum benefit of $1000 per ear every year, and all types of prescription hearing aids are covered with no copay. OTC hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Under the Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) plan, vision services include eye exams and eyewear. Eye exams and eyewear have no copay, and there is a combined maximum plan benefit coverage amount of $300 every year for eyewear. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery, all with no copay; however, Fluoride Treatment, Maxillofacial Prosthetics, Implants Services, and Orthodontics are not covered. This plan offers a maximum of $3,000 per year for Other Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs and Medicare Part B Chemotherapy/Radiation Drugs have no copay. Other Medicare Part B Drugs also have no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) plan, but require prior authorization and a doctor's referral. There is no copay for this service.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment and Diabetic Equipment, is covered by Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP), with no coinsurance. Durable Medical Equipment for use outside the home is not covered, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Prosthetic Devices and Medical Supplies have no coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) 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 specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization and a doctor's referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the plan's copay information is available in the plan details.
Other Services See details
The Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) plan covers acupuncture with no copay, and a limit of 25 treatments per year, and also covers over-the-counter (OTC) items with a maximum benefit of $1200 per year. The plan's meal benefit is covered with no copay. This plan does not cover 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.
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