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Humana Gold Plus H1036-291 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-291 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H1036-291 (HMO-POS) in 2025, please refer to our full plan details page.
Humana Gold Plus H1036-291 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in North Carolina. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H1036-291 (HMO-POS) 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 H1036-291 (HMO-POS).
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 H1036-291 (HMO-POS), 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 $2.00. 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 a $250.00 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 $6750.00 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 H1036-291 (HMO-POS) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy. For preferred brand drugs, you will pay 45% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H1036-291 (HMO-POS) plan offers a wide range of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. Emergency and primary care services have copays, while preventive services, such as annual physical exams, have no copay. Additional benefits include hearing and vision services, with copays for exams and coverage for hearing aids and eyewear. Dental services include no copay for many services, but other services such as home health, ambulance, and skilled nursing facilities have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $399 copay for days 1-7, and no copay for days 8-90, with no coinsurance; for Inpatient Hospital Psychiatric, you will pay a $399 copay for days 1-5, and no copay for days 6-90, with no coinsurance.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay ranging from $0 to $450, observation services with a $399 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $60 and $100 for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. This plan has a $315 copay for both Medicare-covered ground and air ambulance services, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Humana Gold Plus H1036-291 (HMO-POS) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, with no coinsurance for either service. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The Humana Gold Plus H1036-291 (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services with a $15 copay, mental health specialty services with a $60 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $25 copay. Additional telehealth benefits range from no copay to a $60 copay, and opioid treatment program services have a minimum $60 copay and a maximum $100 copay. Podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus H1036-291 (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay. However, services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Hearing exams have a $15 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, with a copay between $399 and $699 for all types. OTC hearing aids are covered up to $50 every three months.
Vision Services See details
Vision services include eye exams with a copay of $0-$15, and eyewear with no copay, including contact lenses and eyeglasses (lenses and frames), with a combined maximum benefit of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include a $15 copay for Medicare dental services, with a $2,500 annual maximum, and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), prosthodontics (fixed), and oral and maxillofacial surgery. Fluoride treatment, maxillofacial prosthetics, implant services, 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, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H1036-291 (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Humana Gold Plus H1036-291 (HMO-POS) plan. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and Diabetic Supplies have a 10-20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services and all radiological services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $120, while Lab Services have no copay; Diagnostic Radiological Services have a copay of up to $325, Therapeutic Radiological Services have a copay of at least $15 and coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H1036-291 (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered by this plan.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required, and the copay information can be found below.
Skilled Nursing Facility (SNF) See details
The Humana Gold Plus H1036-291 (HMO-POS) plan covers Skilled Nursing Facility (SNF) services, but requires prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H1036-291 (HMO-POS) plan covers acupuncture with a $15 copay, and it covers over-the-counter items up to $50 every three months. This plan also covers meal benefits with no copay, but other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and others are not covered.
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