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Humana Gold Plus SNP-DE H1036-314 (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 H1036-314 (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 H1036-314 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Florida counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H1036-314 (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 H1036-314 (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 H1036-314 (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 H1036-314 (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 $520.00 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 H1036-314 (HMO D-SNP) plan has a $520.00 deductible. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will pay no copay at a preferred pharmacy or through preferred mail order, while you will pay a $20.00 copay at a standard mail order pharmacy. For standard generic drugs, you will pay a $47.00 copay at a standard pharmacy or through mail order. Brand name and non-preferred drugs have 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) plan offers comprehensive coverage with no copays for many services, including inpatient hospital stays, outpatient services, primary care visits, preventive services, and home health services. The plan also covers hearing, vision, and dental services, with a $1,000 annual maximum for dental care. This plan provides additional benefits such as coverage for ambulance services, with no copay for ground transport, and a limited number of transportation services to health-related locations. Other covered services include dialysis, medical equipment, diagnostic and radiological services, and acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay for Medicare-covered stays, and no coinsurance. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. There is no copay for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. There is also no copay for individual and group sessions for outpatient substance abuse.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) plan with a $0 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services. Ground ambulance services have no copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay for up to 50 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under this plan. Urgently Needed Services have no copay and no coinsurance, while Worldwide Emergency Services have a copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Occupational Therapy Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a $0 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, Annual Physical Exams with no copay, Additional Preventive Services, Kidney Disease Education Services, and Other Preventive Services. Additional Preventive Services may have a copay, and Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Wigs for Hair Loss Related to Chemotherapy, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams and fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a $1,000 yearly maximum benefit per ear and no copay for all types. Over-the-counter hearing aids are covered up to $125 every three months.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and eyewear has no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $1,000 per year. You will pay no copay for Medicare dental services, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs with no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) plan. There is no copay for dialysis services, but prior authorization and a doctor referral are required.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has no copay and no coinsurance. Prosthetic devices and medical supplies have no copay and no coinsurance. Diabetic supplies and therapeutic shoes/inserts have no copay and no coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests and Outpatient X-Ray Services have no copay, while Lab Services has a $0 copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required.
Other Services See details
The Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) plan covers acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year. Over-the-counter (OTC) items are covered, and the plan offers up to $125 every three months for OTC items, including nicotine replacement therapy and Naloxone. The plan also covers a meal benefit with no copay, and requires prior authorization.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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