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Humana Gold Plus Giveback H1036-319 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-319 (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 H1036-319 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-319 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in WA. 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 H1036-319 (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 H1036-319 (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 H1036-319 (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 $66.00. 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 $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 $8800.00 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 H1036-319 (HMO) prescription drug plan features an annual deductible of $615. For Tier 1 preferred generic drugs, there is no copay for 1-month and 3-month supplies filled at standard pharmacies or through preferred mail order. Tier 2 generic drugs cost $5 for a 1-month supply, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with 3-month supplies costing $131 via preferred mail order and $141 at standard pharmacies. Tier 4 non-preferred drugs carry a 43% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply across all available pharmacy and mail-order services.
Additional Benefits
The Humana Gold Plus Giveback H1036-319 (HMO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care, mental health, and preventive services. For specialized medical needs, members pay a $50 copay for specialist visits, a $115 copay for emergency room care, and a daily copay of $489 for the first five days of acute inpatient hospital stays. Outpatient services feature no coinsurance and variable copays ranging from no copay up to $489. This plan also features key supplemental benefits, including routine dental and vision exams with no copay and no coinsurance, alongside a $250 annual allowance for eyewear and a $1,000 annual limit for dental care. Routine hearing exams are available with no copay, while prescription hearing aids require a copay of $699 to $999. Home health services are covered with no copay, and durable medical equipment is subject to a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Humana Gold Plus Giveback H1036-319 (HMO) with no coinsurance, requiring prior authorization. Acute stays require a $489 daily copay for days 1 to 5 and no copay thereafter, while psychiatric stays require a $416 daily copay for days 1 to 5 and no copay for days 6 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus Giveback H1036-319 (HMO) with no coinsurance, featuring a $0 to $489 copay for outpatient hospital services and a $489 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions have a $0 to $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus Giveback H1036-319 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus Giveback H1036-319 (HMO) covers ambulance services with no coinsurance, requiring prior authorization and a copay of $335 for ground transport and $1,250 for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered under the Humana Gold Plus Giveback H1036-319 (HMO) plan 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 H1036-319 (HMO) provides primary care, mental health, and psychiatric services with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Physical, occupational, and speech therapies have a $35 copay with no coinsurance, whereas chiropractic and podiatry services are not covered. Telehealth and other healthcare professional services feature copays ranging up to $50 with no coinsurance.
Preventive Services See details
Humana Gold Plus Giveback H1036-319 (HMO) covers preventive services—including annual physicals, kidney disease education, glaucoma screenings, diabetes training, and memory fitness—with no copay and no coinsurance. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, 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, additional smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Humana Gold Plus Giveback H1036-319 (HMO) covers Medicare-covered hearing exams for a $50 copay, as well as routine exams and hearing aid fittings with no copay, all with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999 for up to two devices per year, but inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Humana Gold Plus Giveback H1036-319 (HMO) offers partially covered vision services with no deductible, no coinsurance, and no copay for annual routine eye exams and select eyewear, though prior authorization is required. Coverage includes up to a $250 annual maximum for one pair of contact lenses or eyeglasses (lenses and frames), while other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services under the Humana Gold Plus Giveback H1036-319 (HMO) are partially covered up to a $1,000 annual maximum, requiring a $50 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services. While many diagnostic, restorative, and surgical services are covered, fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H1036-319 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while covered Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus Giveback H1036-319 (HMO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Humana Gold Plus Giveback H1036-319 (HMO) covers medical equipment, including durable medical equipment (DME) and prosthetics with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Humana Gold Plus Giveback H1036-319 (HMO) plan, with prior authorization required. Lab services feature no copay and no coinsurance, diagnostic procedures have a $0 to $50 copay with no coinsurance, and radiological services range from no copay for outpatient X-rays to a minimum 20% coinsurance for therapeutic treatments.
Home Health Services See details
Home health services are covered by Humana Gold Plus Giveback H1036-319 (HMO) with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus Giveback H1036-319 (HMO) plan with no coinsurance, though prior authorization is required. Members will pay a $30 copay for both standard and intensive cardiac rehabilitation, and a $10 copay for pulmonary rehabilitation and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H1036-319 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 66 through 100, a $218 daily copay for days 21 through 65, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus Giveback H1036-319 (HMO) partially covers other services, including acupuncture with a $50 copay and no coinsurance for up to 20 treatments per year, and meals for chronic illness with no copay and no coinsurance, both of which require prior authorization. Over-the-counter (OTC) items are not covered under this plan.
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