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Humana Gold Plus H1036-322 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-322 (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 H1036-322 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-322 (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 H1036-322 (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 H1036-322 (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 H1036-322 (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.
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 $200.00 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 H1036-322 (HMO) plan features a $200 annual drug deductible and offers excellent savings on generic medications. Under this plan, Tier 1 preferred generic drugs have no copay for 1-month and 3-month supplies at standard pharmacies and preferred mail order. Tier 2 generic drugs require a $10 copay for a 1-month supply, but have no copay for a 3-month supply through preferred mail order. For brand-name and specialty medications, costs vary depending on the drug tier. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with slightly lower rates available for 3-month preferred mail orders. Tier 4 non-preferred drugs carry a 48% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus H1036-322 (HMO) plan offers affordable healthcare coverage featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $40 copay, while inpatient hospital stays cost a $450 copay for days 1 through 5 with no copay for subsequent days. Emergency care is available with a $130 copay, and outpatient diagnostic services like lab tests and X-rays are covered with no copay. For supplemental care, members benefit from no copay and no coinsurance on routine dental and vision exams, with dental coverage extending up to a $2,000 annual limit and vision hardware covered up to $250. Routine hearing exams and over-the-counter hearing aids also feature no copay, though prescription hearing aids require copays ranging from $699 to $999. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H1036-322 (HMO) covers inpatient hospital services with no coinsurance, requiring a $450 copay for days 1 through 5 and no copay for days 6 and beyond. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the Humana Gold Plus H1036-322 (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $450, including a $450 copay per stay for observation services, while outpatient substance abuse sessions range from no copay to a $35 copay.
Partial Hospitalization See details
Humana Gold Plus H1036-322 (HMO) 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 H1036-322 (HMO) covers Medicare-covered ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, both featuring no coinsurance and requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H1036-322 (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 and 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 H1036-322 (HMO) covers primary care physician visits and mental health sessions with no copay and no coinsurance. Specialist visits require a $40 copay, physical and occupational therapies have a $45 copay, and telehealth benefits range from a $0 to $50 copay, all with no coinsurance. Routine chiropractic and podiatry services are not covered under these benefits.
Preventive Services See details
Preventive Services are partially covered under the Humana Gold Plus H1036-322 (HMO) plan, offering annual physicals, kidney disease education, and routine screenings with no copay and no coinsurance. While alternative therapies ($20 copay) and memory fitness (no copay) are covered with no coinsurance, several supplemental services—including health education, nutritional therapy, weight management, and in-home safety assessments—are not covered.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H1036-322 (HMO), including routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Medicare-covered exams require a $40 copay and no coinsurance, while prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Humana Gold Plus H1036-322 (HMO) provides partially covered vision services with no deductible, no copays, and no coinsurance for one routine eye exam and one pair of contact lenses or eyeglasses per year, up to a $250 limit. Other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-322 (HMO) partially covers dental services, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services up to a $2,000 annual limit. Excluded from coverage are fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Humana Gold Plus H1036-322 (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs are covered with no copay and coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H1036-322 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H1036-322 (HMO) covers durable medical equipment 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 and inserts require a $10 copay and coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-322 (HMO) covers diagnostic and radiological services, with prior authorization required for all services. Members will pay no copay for lab services and outpatient X-rays, a $0 to $50 copay with no coinsurance for diagnostic procedures and tests, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Humana Gold Plus H1036-322 (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-322 (HMO) covers some cardiac rehabilitation services with no coinsurance and required prior authorization. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Humana Gold Plus H1036-322 (HMO) with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 50, and no copay for days 51 to 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1036-322 (HMO) covers acupuncture with a $20 copay and no coinsurance for up to 25 treatments per year, subject to prior authorization. The plan also covers chronic illness meal benefits and over-the-counter items with no copay and no coinsurance, though the over-the-counter benefit is partially covered as it excludes some drugs on the CMS OTC list.
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