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Humana Gold Plus Giveback H1036-305 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-305 (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 H1036-305 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-305 (HMO) is a HMO 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 Giveback H1036-305 (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 H1036-305 (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 H1036-305 (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 $148.00. 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 $3850.00 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 H1036-305 (HMO) plan features a $0 prescription drug deductible, meaning your coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay for one-month or three-month supplies filled at standard pharmacies or through preferred mail order. Standard mail order for these generic tiers incurs small copays, ranging from $5 to $20 for a one-month supply. Tier 3 preferred brand drugs are available with a $30 copay for a one-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. Higher-tier medications require coinsurance instead of copays, with Tier 4 non-preferred drugs carrying a 35% coinsurance and Tier 5 specialty drugs requiring a 33% coinsurance.
Additional Benefits
The Humana Gold Plus Giveback H1036-305 (HMO) plan offers robust coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $250 for the first seven days and no copay for days eight through 90, with no coinsurance. Outpatient services, emergency care, and specialist visits are also covered with predictable copayments and no coinsurance, ensuring manageable out-of-pocket costs. This plan also features valuable supplemental benefits, including no copay for routine hearing exams, routine vision exams, and preventive dental care up to a $1,000 annual limit. Additionally, members can access up to 50 one-way transportation trips to plan-approved locations and pay no copay or coinsurance for prosthetics and medical supplies. While durable medical equipment and dialysis services require coinsurance, many diagnostic services like lab tests and outpatient X-rays are available with no copay.
Inpatient Hospital See details
Humana Gold Plus Giveback H1036-305 (HMO) covers inpatient hospital stays with no coinsurance, requiring a $250 daily copay for days 1 through 7 and no copay for days 8 through 90. This benefit is partially covered because psychiatric stays beyond 90 days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H1036-305 (HMO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $250, observation services require a $250 copay per stay, and outpatient substance abuse sessions range from no copay to a $20 copay.
Partial Hospitalization See details
Humana Gold Plus Giveback H1036-305 (HMO) covers partial hospitalization services with a $25.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus Giveback H1036-305 (HMO) covers ground ambulance services with a copay of $0 to $240 and air ambulance services with a 20% coinsurance, requiring prior authorization for all ambulance services. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus Giveback H1036-305 (HMO) offers emergency services with a $150 copay and no coinsurance, which 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 available for a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Giveback H1036-305 (HMO) covers primary care visits with no copay and no coinsurance, while specialists, physical therapy, occupational therapy, and podiatry require a $30 copay and no coinsurance. Mental health and psychiatric services have a $20 copay and no coinsurance, other services like telehealth and opioid treatment range from no copay up to $30 with no coinsurance, and chiropractic care is not covered.
Preventive Services See details
Humana Gold Plus Giveback H1036-305 (HMO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive services are only partially covered, offering a memory fitness benefit with no copay, while excluding services like health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Humana Gold Plus Giveback H1036-305 (HMO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $30 copay and no coinsurance. Some prescription hearing aid services are covered up to $500 per ear annually with no copay or coinsurance, but OTC hearing aids, inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus Giveback H1036-305 (HMO) with no deductibles or coinsurance, featuring a $0 to $30 copay for eye exams (including one routine exam annually at no copay) and no copay for eyeglasses or contact lenses up to a $200 yearly limit. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Humana Gold Plus Giveback H1036-305 (HMO), featuring a $1,000 annual limit with no copay and no coinsurance for preventive services like cleanings, exams, and x-rays. Medicare-covered dental services require a $30 copay and no coinsurance, while restorative care has a $25 copay and no coinsurance. Fluoride, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H1036-305 (HMO) covers home infusion bundled services with no copay, with prior authorization required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while covered Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus Giveback H1036-305 (HMO) with no copay and a 20% coinsurance. This benefit requires both a referral and prior authorization.
Medical Equipment See details
Humana Gold Plus Giveback H1036-305 (HMO) covers durable medical equipment (DME) with a 10% coinsurance and no copay, and prosthetics and medical supplies with no copay or coinsurance. Covered diabetic supplies require a 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts are covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus Giveback H1036-305 (HMO), with prior authorizations and referrals required for all services. Members pay no copay for lab services and outpatient X-rays, a $0 to $100 copay with no coinsurance for diagnostic tests, and a minimum $20 copay and 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by Humana Gold Plus Giveback H1036-305 (HMO) with no copay and no coinsurance. A referral and prior authorization are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus Giveback H1036-305 (HMO) plan, as intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are all listed as not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H1036-305 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $60 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus Giveback H1036-305 (HMO) partially covers other services, offering acupuncture up to 25 treatments per year and chronic illness meal benefits with no copay and no coinsurance, though prior authorization is required. Over-the-counter (OTC) items are not covered under this benefit.
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