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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 2026, 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 4.5 out of 5 stars in 2026.
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 $129.00. 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 $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 Gold Plus Giveback H1036-318 (HMO-POS) prescription drug plan features an annual drug deductible of $450. Tier 1 preferred generic drugs have no copay for a 1-month or 3-month supply at standard pharmacies and preferred mail order. Tier 2 generic drugs require a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, but there is no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs cost a $47 copay for a 1-month supply, which drops to $131 for a 3-month supply when using preferred mail order. For higher-tier prescriptions, Tier 4 non-preferred drugs have a 46% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs require a 27% coinsurance for a 1-month supply across standard pharmacies and mail order options.
Additional Benefits
The Humana Gold Plus Giveback H1036-318 (HMO-POS) plan offers comprehensive medical coverage with no copays for primary care visits, preventive care, and home health services. Inpatient hospital stays require a $375 daily copay for the first seven days, with no copay for subsequent days, while specialist visits carry a $40 copay. Emergency care is available with a $115 copay, which is waived if you are admitted, and ambulance services require a $335 copay. Routine dental, vision, and hearing exams are covered with no copays, though hearing aids require copays ranging from $699 to $999 and eyewear is limited to a $150 annual allowance. Skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Durable medical equipment and dialysis services generally require a 20% coinsurance with no copayments.
Inpatient Hospital See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers inpatient acute hospital stays with no coinsurance, requiring prior authorization, a $375 daily copay for days 1-7, and no copay for days 8 and beyond. Inpatient psychiatric stays are also covered with no coinsurance, requiring a $375 daily copay for days 1-5 and no copay for days 6-90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $450 for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers ground and air ambulance services with a $335 copay and no coinsurance, requiring prior authorization. While some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers primary care physician visits with no copay and no coinsurance, while specialist visits require a $40 copay and therapy services require a $25 copay, both with no coinsurance. Mental health, psychiatric, and telehealth services have copays ranging up to $40 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Humana Gold Plus Giveback H1036-318 (HMO-POS) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings like glaucoma and diabetes self-management. However, this benefit is only partially covered as additional services such as fitness benefits, health education, and in-home safety assessments are not covered.
Hearing Services See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $699 to $999 and no coinsurance for up to two devices per year, though inner-ear, outer-ear, over-the-ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered under Humana Gold Plus Giveback H1036-318 (HMO-POS), which offers routine eye exams with no deductible, no copay, and no coinsurance, though other eye exam services are not covered. Eyewear is covered up to a $150 annual limit with no deductible, no copay, and no coinsurance for contact lenses and eyeglasses (lenses and frames), but individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) features partially covered dental services with no copay and no coinsurance for preventive and most comprehensive care, while Medicare-covered dental services require a $40 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin drugs specifically requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus Giveback H1036-318 (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers medical equipment, featuring a 20% coinsurance and no copayment for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with a 10% to 20% coinsurance and no copayment, while diabetic therapeutic shoes and inserts require a $10 copayment.
Diagnostic and Radiological Services See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers diagnostic and radiological services, which require prior authorization. Lab services and outpatient X-rays feature no copay, diagnostic tests range from a $0 to $120 copay with no coinsurance, and therapeutic radiological services require a minimum $40 copay and a minimum 20% coinsurance.
Home Health Services See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Humana Gold Plus Giveback H1036-318 (HMO-POS) feature no coinsurance, and while some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copays ranging from $20 to $30.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H1036-318 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires no prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus Giveback H1036-318 (HMO-POS), offering acupuncture with a $40 copay and no coinsurance, and meal benefits with no copay and no coinsurance. Prior authorization is required for these covered services, while over-the-counter (OTC) items are not covered.
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