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Humana Gold Plus SNP-DE H1036-304 (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 H1036-304 (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 H1036-304 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Broward, Miami-Dade, and Palm Beach 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 SNP-DE H1036-304 (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 H1036-304 (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 H1036-304 (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 H1036-304 (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 $400.00 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 H1036-304 (HMO D-SNP) plan features an annual drug deductible of $400. Beneficiaries pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) prescription drugs when filled at a standard pharmacy or through preferred mail order. If you choose standard mail order for these generic tiers, you will face copays ranging from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 (Preferred Brand) and Tier 4 (Non-Preferred Drug) prescriptions require a 25% coinsurance at standard pharmacies and through both preferred and standard mail order services. Tier 5 (Specialty Tier) medications carry a 28% coinsurance for a 1-month supply across all standard retail and mail order options.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) plan offers comprehensive medical coverage with no copays and no coinsurance for nearly all primary services. Members enjoy no-cost benefits for inpatient and outpatient hospital stays, primary and specialist doctor visits, emergency services, and preventive care. This plan also features robust coverage for dental, vision, and hearing services, including no copays and no deductibles for routine exams. To help cover costs, the plan provides generous annual allowances, including up to $3,000 for dental care, $600 for eyewear, and $1,500 per ear for prescription hearing aids. While almost all services are available with no out-of-pocket costs, a 20% coinsurance applies to air ambulance transportation. Additionally, members should be aware that many covered benefits, such as medical equipment, home health, and specialist care, require prior authorization or referrals.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) covers inpatient hospital services for acute and psychiatric stays with no copay and no coinsurance, though prior authorization is required. These services are partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Outpatient Services are covered by Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) with no copay and no coinsurance for outpatient hospital care, ambulatory surgical center services, outpatient substance abuse sessions, and blood services. Prior authorization and referrals are required for these covered outpatient benefits.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) plan, offering ground ambulance services with no copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Plan transportation is partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) covers emergency services, urgently needed care, and worldwide emergency services with no copay and no coinsurance. This includes worldwide emergency coverage, urgent coverage, and emergency transportation, all provided at no cost to the member.
Primary Care See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) primary care benefits feature no copay and no coinsurance for most services, including primary care physician visits, specialist visits, physical therapy, and mental health services. However, podiatry services and other chiropractic services are not covered, making chiropractic care only partially covered with a limit of 12 routine visits per year.
Preventive Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, or counseling.
Hearing Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) covers hearing exams and fittings with no copay, no coinsurance, and no deductible. Hearing aids are partially covered with no copay or coinsurance, providing up to two OTC devices and up to $1,500 per ear annually for prescription models, excluding inner ear, outer ear, and over-the-ear prescription hearing aids.
Vision Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible, though prior authorization and referrals are required. Covered benefits include one routine eye exam per year and up to $600 annually for contact lenses and eyeglasses (lenses and frames), while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $3,000. Covered services include preventive and comprehensive care like cleanings, exams, and restorative work, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) covers home infusion bundled services, including Medicare Part B chemotherapy, radiation, insulin, and other Part B drugs, with no copay and no coinsurance. Prior authorization is required for these services, and step therapy may apply when transitioning from Part B to Part D drugs.
Dialysis Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) covers dialysis services with no copay and no coinsurance, although prior authorization and a referral are required.
Medical Equipment See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copays and no coinsurance. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) covers diagnostic and radiological services with no copays and no coinsurance. These covered benefits include lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays, though prior authorization and referrals are required.
Home Health Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP), offering days 1 through 100 with no copay and no coinsurance, and requiring no prior 3-day inpatient hospital stay. Prior authorization is required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) partially covers other services with no copay and no coinsurance, including up to 25 acupuncture treatments per year, over-the-counter items, and meal benefits. Prior authorization is required for acupuncture and meal benefits, while highly integrated services for dual eligibles and other miscellaneous services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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