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Humana Gold Plus Giveback H1036-286 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-286 (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 H1036-286 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-286 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Indian River, Martin, St. Lucie counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus Giveback H1036-286 (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 H1036-286 (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 H1036-286 (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 $110.00. 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 $5500.00 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 H1036-286 (HMO) plan has no deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy used. For example, in the initial coverage phase, you will pay no copay for preferred generic drugs at a standard pharmacy or through preferred mail order, while standard mail order will cost you a $20 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus Giveback H1036-286 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary, and emergency services have a $125 copay. Preventive, primary care, and home health services have no copay, along with other services like hearing exams and eyewear. However, services like ambulance, vision, dental, and dialysis services have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-7, and no copay for days 8-90, and for additional days, you have no copay. For Inpatient Hospital Psychiatric, you pay a $275 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $350, and observation services with a $275 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a copay between $30 and $100 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus Giveback H1036-286 (HMO) plan, with a $50 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a copay between $0 and $240, while air ambulance services have a 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Emergency Services, Urgently Needed Services, and Worldwide Emergency Services, are covered by the Humana Gold Plus Giveback H1036-286 (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $125 copay with no coinsurance, while Urgently Needed Services have a $15 copay with no coinsurance.
Primary Care See details
The Humana Gold Plus Giveback H1036-286 (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, and occupational therapy services have a $35 copay. Physician specialist services, physical therapy, and speech-language pathology services each have a $35 copay, with a referral and prior authorization required. Mental health and psychiatric services have a copay of $30, and podiatry services have a copay of $35. Additional telehealth benefits have a copay between $0 and $35, and opioid treatment program services have a copay between $30 and $100.
Preventive Services See details
The Humana Gold Plus Giveback H1036-286 (HMO) plan covers preventive services including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, but may have a copay.
Hearing Services See details
The Humana Gold Plus Giveback H1036-286 (HMO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $750 per year, with no copay for all types, but inner, outer, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus Giveback H1036-286 (HMO) plan covers vision services including routine eye exams with a copay between $0 and $35, and eyewear with a $0 copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus Giveback H1036-286 (HMO) plan covers Medicare Dental Services with a $35 copay, and other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. Prosthodontics, removable has a 30% coinsurance, while fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
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 coinsurance between 0-20%, while the other drugs have coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus Giveback H1036-286 (HMO) plan, but require prior authorization and a doctor's referral. You will be responsible for 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Diabetic Supplies have a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus Giveback H1036-286 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $125, and Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus Giveback H1036-286 (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 the sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus Giveback H1036-286 (HMO) plan, 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 for SNF are not covered.
Other Services See details
The Humana Gold Plus Giveback H1036-286 (HMO) plan covers acupuncture with no copay, but a prior authorization is required and is limited to 25 treatments per year. Other services, including over-the-counter items, meal benefits, and several additional services, are not covered.
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