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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 2026, 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 4.5 out of 5 stars in 2026.
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 $113.00. 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for 1-month and 3-month supplies at standard pharmacies or through preferred mail order. If you choose standard mail order, these generic drugs require a copay ranging from $10 to $20 for a 1-month supply. For Tier 3 preferred brand drugs, copays start at $30 for a 1-month supply at standard pharmacies and through preferred mail order. Tier 4 non-preferred drugs require a 35% coinsurance across all pharmacy options, while Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply. This plan offers clear, structured cost-sharing to help you manage your prescription expenses.
Additional Benefits
The Humana Gold Plus Giveback H1036-286 (HMO) offers comprehensive medical coverage featuring no copay for primary care visits, preventive services, and routine eye exams. Specialist visits require a $40 copay, while inpatient hospital stays cost a $275 daily copay for the first seven days before transitioning to no copay. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital. This plan also includes valuable supplemental benefits, such as dental coverage of up to $2,500 annually with no copay for preventive care and most comprehensive services. Additionally, members benefit from no copay on routine hearing exams and up to $750 per ear for prescription hearing aids, alongside a $200 annual allowance for eyewear with no copay. Other essential services, including home health visits and laboratory tests, are also fully covered with no copay.
Inpatient Hospital See details
Inpatient hospital benefits under the Humana Gold Plus Giveback H1036-286 (HMO) are partially covered with no coinsurance, requiring a $275 daily copay for days 1 to 7 and no copay for days 8 to 90 for acute and psychiatric stays. Prior authorization is required, and exclusions apply as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H1036-286 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $350 ($275 per stay for observation services), and outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the Humana Gold Plus Giveback H1036-286 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services under the Humana Gold Plus Giveback H1036-286 (HMO) require prior authorization, with ground ambulance services costing a copay of $0 to $240 and air ambulance services requiring a 20% coinsurance. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus Giveback H1036-286 (HMO) covers emergency services with a $130 copay and no coinsurance, and this copay 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 H1036-286 (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Covered physical, occupational, speech, and podiatry therapies have copays ranging from $35 to $40 with no coinsurance, though chiropractic services are not covered. Mental health, psychiatric, and opioid treatment services are also available with a $30 copay and no coinsurance.
Preventive Services See details
Preventive services are covered by Humana Gold Plus Giveback H1036-286 (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive benefits are partially covered, offering a memory fitness program, but excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus Giveback H1036-286 (HMO) partially covers hearing services, featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered with no copay or coinsurance up to $750 per ear annually, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Humana Gold Plus Giveback H1036-286 (HMO) vision services are partially covered, featuring routine eye exams with no copay and other exams with a $0 to $40 copay, all with no coinsurance. Eyewear is covered up to $200 yearly with no copay or coinsurance for contact lenses and eyeglasses (lenses and frames), but other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus Giveback H1036-286 (HMO), featuring an annual maximum of $2,500 with no copay and no coinsurance for preventive and most comprehensive care, though removable prosthodontics require no copay and 30% coinsurance. Medicare-covered dental services require a $40 copay and no coinsurance, while fluoride treatments, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H1036-286 (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy and other drugs require no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs have a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Plus Giveback H1036-286 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Humana Gold Plus Giveback H1036-286 (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic services, with prior authorization required. Covered DME, diabetic supplies, and therapeutic shoes feature no copay and a 20% coinsurance, while medical supplies require a copayment and 20% coinsurance, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus Giveback H1036-286 (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $125 copay for diagnostic procedures. Radiological services require a $35 copay and 20% coinsurance for therapeutic services, while diagnostic radiology and outpatient X-rays have no copay, with prior authorization required for both service types.
Home Health Services See details
Humana Gold Plus Giveback H1036-286 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus Giveback H1036-286 (HMO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization, but only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice. These excluded services have copays ranging from $15 to $25 depending on the specific therapy.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H1036-286 (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 and a $160 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Humana Gold Plus Giveback H1036-286 (HMO) partially covers other services, offering acupuncture with no copay and no coinsurance for up to 25 treatments per year, though prior authorization is required. Over-the-counter items, meal benefits, and dual-eligible SNP services are not covered.
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