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Humana Dual Select H1036-307 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Select H1036-307 (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 Dual Select H1036-307 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Dual Select H1036-307 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in North Carolina. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Dual Select H1036-307 (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 Dual Select H1036-307 (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 Dual Select H1036-307 (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 Dual Select H1036-307 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.00. 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 $615.00 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 $9250.00 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 Dual Select H1036-307 (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay for 1-month and 3-month supplies filled at standard retail pharmacies or through preferred mail order. If you use standard mail order, you will pay a $10 copay for Tier 1 and a $20 copay for Tier 2 for a 1-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty medications, you will pay a 25% coinsurance. This 25% coinsurance applies to standard pharmacies, preferred mail order, and standard mail order options. It covers 1-month and 3-month supplies for Tiers 3 and 4, and 1-month supplies for Tier 5.
Additional Benefits
The Humana Dual Select H1036-307 (HMO D-SNP) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, routine annual physicals, and home health services. Routine vision, hearing, and dental care are also covered with no copays, featuring helpful extras like a $350 annual eyewear allowance and a $2,000 yearly dental limit. For other outpatient services, members will pay a $25 copay for specialist visits, physical therapy, and Medicare-covered hearing or dental exams. For emergency and hospital care, inpatient stays and skilled nursing facility visits require daily copays for initial days but feature no coinsurance. Emergency room visits have a $115 copay, which is waived if you are admitted to the hospital within 24 hours. High-level medical needs, including dialysis, durable medical equipment, and home infusion drugs, require a 20% coinsurance.
Inpatient Hospital See details
Humana Dual Select H1036-307 (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, there is a $399 copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $399 copay for days 1 to 5 and no copay for days 6 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Humana Dual Select H1036-307 (HMO D-SNP) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $399 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copays, while outpatient substance abuse individual and group sessions require a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Dual Select H1036-307 (HMO D-SNP) plan with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Dual Select H1036-307 (HMO D-SNP) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Humana Dual Select H1036-307 (HMO D-SNP) with a $115 copay, which is waived if you are admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $115 copay and no coinsurance.
Primary Care See details
Humana Dual Select H1036-307 (HMO D-SNP) offers primary care physician services with no copay and no coinsurance, while specialist, occupational, and physical therapy visits require a $25 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $35 copay with no coinsurance, but podiatry is not covered and routine and other chiropractic services are not covered.
Preventive Services See details
Humana Dual Select H1036-307 (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, memory fitness, and glaucoma screenings. However, supplemental services such as health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, bathroom safety, and counseling are not covered.
Hearing Services See details
Humana Dual Select H1036-307 (HMO D-SNP) covers routine hearing exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance, while Medicare-covered hearing exams require a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two devices every three years, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Dual Select H1036-307 (HMO D-SNP) with no copays, no coinsurance, and no deductibles, though prior authorization is required. This benefit includes one routine eye exam per year and a $350 annual allowance for one pair of eyeglasses or contact lenses, but other eye exams, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Dual Select H1036-307 (HMO D-SNP) dental services are partially covered, offering up to a $2,000 annual maximum with no copay and no coinsurance for most preventive and comprehensive services. Medicare-covered dental services require a $25 copay and no coinsurance, but fluoride treatments, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Dual Select H1036-307 (HMO D-SNP) with prior authorization, featuring a 0% to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered insulin requires a $35 copay and 0% to 20% coinsurance, other Part B drugs have no copay, and step therapy may apply.
Dialysis Services See details
Dialysis Services are covered under the Humana Dual Select H1036-307 (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Dual Select H1036-307 (HMO D-SNP) covers medical equipment—including durable medical equipment, prosthetic devices, medical supplies, and diabetic services—with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Dual Select H1036-307 (HMO D-SNP) covers diagnostic and radiological services, with prior authorization required. Lab services, diagnostic radiology, and outpatient X-rays feature no copay, while diagnostic procedures range from no copay up to a $120 copay with 20% coinsurance, and therapeutic radiological services require a minimum $25 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Dual Select H1036-307 (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Dual Select H1036-307 (HMO D-SNP) with no copay and no coinsurance, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, and prior authorization is required for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Dual Select H1036-307 (HMO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Humana Dual Select H1036-307 (HMO D-SNP) provides acupuncture with a $25 copay and no coinsurance for up to 20 treatments yearly, as well as over-the-counter items and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while highly integrated services and other miscellaneous benefits are not covered.
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