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Humana Gold Plus H1036-321 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-321 (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 H1036-321 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-321 (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 H1036-321 (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 H1036-321 (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 H1036-321 (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 $1.00. 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 $5900.00 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 H1036-321 (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generics, members pay no copay at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a one-month supply at standard pharmacies and preferred mail order, with no copay for a three-month supply via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a one-month supply, which reduces to a $131 copay for a three-month supply when using preferred mail order. Tier 4 non-preferred drugs carry a 50% coinsurance across standard pharmacies and mail-order options. Specialty medications in Tier 5 require a 25% coinsurance for a one-month supply.
Additional Benefits
Humana Gold Plus H1036-321 (HMO) provides comprehensive medical coverage with no copays for primary care visits, mental health services, and preventive care, while specialist visits require a $25 copay. Inpatient hospital stays require a daily copay of $390 for the first five days and no copay thereafter, with no coinsurance. Outpatient services, emergency care, and urgent care are also covered with fixed copays and no coinsurance. The plan also features robust dental, vision, and hearing benefits, including up to $3,000 annually for dental care and up to $400 for eyewear with no copays. Routine hearing exams and over-the-counter hearing aids are covered with no copay, though prescription hearing aids carry copays ranging from $299 to $599. Additionally, durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Humana Gold Plus H1036-321 (HMO) with no coinsurance, requiring a daily copay of $390 for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though additional acute hospital days are unlimited with no copay.
Outpatient Services See details
Humana Gold Plus H1036-321 (HMO) covers outpatient services with no coinsurance, featuring a copay of $0 to $390 for outpatient hospital services and $390 per stay for observation services. There is no copay or coinsurance for ambulatory surgical center and outpatient blood services, while outpatient substance abuse sessions require a copay of $0 to $35.
Partial Hospitalization See details
Humana Gold Plus H1036-321 (HMO) covers partial hospitalization services 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 H1036-321 (HMO) covers ambulance services with no coinsurance, requiring a $335 copay for ground ambulance services and a $1,250 copay for air ambulance services. Routine transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H1036-321 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-321 (HMO) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Physical, occupational, and speech therapies require a $20 copay and no coinsurance, while chiropractic care is partially covered with a $15 copay and no coinsurance for up to 12 routine visits yearly. Mental health and psychiatric services feature no copay and no coinsurance, but podiatry services are not covered.
Preventive Services See details
Preventive services under the Humana Gold Plus H1036-321 (HMO) plan are partially covered, featuring no copay and no coinsurance for annual physicals, kidney disease education, and routine screenings. While memory fitness has no copay and alternative therapies have a $20 copay (both with no coinsurance), several supplemental benefits are not covered, including health education, PERS, medical nutrition therapy, weight management, therapeutic massage, and in-home support.
Hearing Services See details
Hearing services covered by Humana Gold Plus H1036-321 (HMO) include Medicare-covered exams for a $25 copay and no coinsurance, alongside routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $299 to $599, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H1036-321 (HMO) with no coinsurance, offering eye exams with a $0 to $25 copay and eyewear with no copay up to a $400 annual limit. While routine eye exams, contact lenses, and complete eyeglasses are covered, other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-321 (HMO) offers partially covered dental services with a $3,000 annual maximum, requiring a $25 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most other services. While preventive and comprehensive care like cleanings, X-rays, and extractions are covered, fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-321 (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1036-321 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H1036-321 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Humana Gold Plus H1036-321 (HMO), with prior authorization required. Lab services have no copay and no coinsurance, diagnostic tests carry a $0 to $50 copay with no coinsurance, outpatient X-rays have no copay, diagnostic radiology has a $0 minimum copay with no coinsurance, and therapeutic radiology requires a minimum 20% coinsurance with no copay.
Home Health Services See details
Humana Gold Plus H1036-321 (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H1036-321 (HMO) with no coinsurance and require prior authorization, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, carrying copayments ranging from $5 to $10.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-321 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is a daily copay of $10 for days 1 through 20 and $218 for days 21 through 50, followed by no copay for days 51 through 100, though additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus H1036-321 (HMO) with no copay and no coinsurance for acupuncture, chronic illness meals, and reimbursed over-the-counter (OTC) items. Prior authorization is required for acupuncture and meals, and some CMS OTC list drugs and other miscellaneous services are not covered.
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