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Humana Gold Plus Giveback H1036-318 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-318 (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 Giveback H1036-318 (HMO-POS) in 2025, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-318 (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 Giveback H1036-318 (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 Giveback H1036-318 (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 Giveback H1036-318 (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 $119.00. 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 $450.00 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 $9350.00 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 H1036-318 (HMO-POS) plan has a $450 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $5 copay at preferred mail order pharmacies and a $20 copay at standard mail order pharmacies. For standard generic drugs, you will pay a $47 copay regardless of the pharmacy. For preferred brand drugs, you will pay 40% coinsurance, and for non-preferred drugs, you will pay 27% coinsurance. Once your total yearly drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus Giveback H1036-318 (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, and outpatient services like hospital visits and substance abuse treatment with varying copays. It also covers emergency services, primary care visits, preventive services, and vision and dental services, often with no copay. This plan provides coverage for hearing exams and aids, home health services, and skilled nursing facility stays. Additionally, it includes benefits like ambulance services, medical equipment, and diagnostic services, with specific copays or coinsurance amounts depending on the service.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $399 for days 1-6, and no copay for days 7-90 for acute care, and a $399 copay for days 1-5, and no copay for days 6-90 for psychiatric care. Additional days for Inpatient Hospital-Acute have no copay, while non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $450, Observation Services with a $399 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $45 to $100 copay for individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus Giveback H1036-318 (HMO-POS) plan, with an $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a copay of $315.00, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus Giveback H1036-318 (HMO-POS) plan. Emergency Services has a $110 copay and no coinsurance, Urgently Needed Services has a $45 copay and no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus Giveback H1036-318 (HMO-POS) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, and Physician Specialist Services with a $45 copay. Mental Health Specialty Services and Psychiatric Services have a $45 copay for individual and group sessions, while Physical Therapy and Speech-Language Pathology Services have a $25 copay, and Additional Telehealth Benefits have a copay ranging from $0 to $45. Opioid Treatment Program Services have a copay between $45 and $100.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, while additional preventive services such as health education and weight management programs are not covered. Other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a copay between $699 and $999, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus Giveback H1036-318 (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$45, contact lenses and eyeglasses (lenses and frames) with no copay, and an annual combined maximum of $150 for all eyewear. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus Giveback H1036-318 (HMO-POS) plan covers Medicare Dental Services with a $45 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. However, fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, 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. 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 under the Humana Gold Plus Giveback H1036-318 (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, and Medical Supplies, is covered under this plan. DME has a 12% coinsurance, and Prosthetic Devices have a 20% coinsurance; Medical Supplies also have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and 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 at most $325, and Therapeutic Radiological Services have a coinsurance of at most 20% and a copay of at most $45. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus Giveback H1036-318 (HMO-POS) 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 covered by the Humana Gold Plus Giveback H1036-318 (HMO-POS) plan, but specific services like Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus Giveback H1036-318 (HMO-POS) plan, with no copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus Giveback H1036-318 (HMO-POS) plan covers acupuncture with a $45 copay and a limit of 20 treatments per year, and also covers meal benefits with no copay. Other services such as over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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