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Humana Gold Plus SNP-DE H1036-320 (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 H1036-320 (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 H1036-320 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in Kentucky. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus SNP-DE H1036-320 (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 H1036-320 (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 H1036-320 (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 H1036-320 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.40. 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 Gold Plus SNP-DE H1036-320 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay for 1-month and 3-month supplies filled at standard pharmacies or through preferred mail order. If you use standard mail order, Tier 1 drugs require a $10 copay for a 1-month supply and a $30 copay for a 3-month supply, while Tier 2 drugs require a $20 copay for a 1-month supply and a $60 copay for a 3-month supply. For higher-tier medications, including Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance applies to both 1-month and 3-month supplies of Tier 3 and Tier 4 drugs at standard pharmacies, preferred mail order, and standard mail order. Tier 5 specialty medications also carry a 25% coinsurance for a 1-month supply across standard pharmacies, preferred mail order, and standard mail order.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) offers comprehensive medical coverage, with many essential healthcare services requiring no copay. Outpatient services, primary care visits, and specialist consultations are covered with no copay and a 20% coinsurance, while inpatient hospital stays require a copay of $2,230 per acute stay and $2,080 per psychiatric stay. Preventive care and home health services are fully covered with no copay and no coinsurance to help you manage your health affordably. This plan also includes valuable supplemental benefits, such as routine dental care up to a $1,000 annual maximum and eyewear up to a $150 yearly limit with no copay or coinsurance. Routine hearing exams, hearing aids, and up to 36 plan-approved one-way transportation trips per year are also provided with no copay. Most diagnostic services and durable medical equipment are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per acute care stay and a $2,080 copay per psychiatric stay. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Outpatient services under the Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) are covered with no copay and a 20% coinsurance. Covered benefits include outpatient hospital, ambulatory surgical center, substance abuse, and blood services, all of which require prior authorization.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance. Plan-approved transportation services are also covered with no copay or coinsurance for up to 36 one-way trips per year, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) 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 20% coinsurance (up to $40) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) offers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance. Chiropractic services are partially covered with no copay and 20% coinsurance, though other chiropractic services and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) covers preventive services, such as annual physical exams and kidney disease education, with no copays and no coinsurance. However, these benefits are only partially covered, as 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, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP), featuring routine exams with a 20% coinsurance and no copay, and unlimited fitting evaluations with no copay. Prescription hearing aids (up to two every three years) and OTC hearing aids are covered with no copay and no coinsurance, though prescription aids are only partially covered as inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) provides partially covered vision services with no deductible, featuring one annual routine eye exam with no copay and 20% coinsurance. Eyewear is covered up to a $150 annual maximum with no copay or coinsurance for one pair of contacts or eyeglasses (lenses and frames) per year, though separate eyeglass lenses, frames, upgrades, and other eye exams are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) covers Medicare-covered dental services with no copay and 20% coinsurance, and other dental services with no copay and no coinsurance up to a $1,000 annual maximum. The dental benefit is partially covered, excluding fluoride treatment, endodontics, implants, orthodontics, oral and maxillofacial surgery, maxillofacial prosthetics, and fixed or removable prosthodontics.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) covers home infusion bundled services with prior authorization and step therapy, requiring a 0% to 20% coinsurance for Part B chemotherapy, radiation, and other drugs. Covered Part B insulin has a $35 copay and 0% to 20% coinsurance, while other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) covers durable medical equipment, prosthetics, 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
Diagnostic and radiological services are covered by Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) with prior authorization required. Diagnostic tests and lab services feature no copay and a 20% coinsurance, while radiological services require a 20% coinsurance alongside copays of $50 for x-rays and $200 for diagnostic radiological services.
Home Health Services See details
Home health services are covered by the Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) covers cardiac rehabilitation services with no copay and prior authorization. While some services are covered, specific options like standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, offering 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 required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are covered by Humana Gold Plus SNP-DE H1036-320 (HMO D-SNP), including acupuncture with no copay and 20% coinsurance, and meal benefits with no copay and no coinsurance, both requiring prior authorization. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance via reimbursement, as some drugs on the CMS OTC list are not covered.
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