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Humana Gold Plus Giveback H1036-323 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H1036-323 (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 H1036-323 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H1036-323 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in OR. 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 H1036-323 (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 H1036-323 (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 H1036-323 (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 $61.00. 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 H1036-323 (HMO) plan features a drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a 1-month supply at standard pharmacies, or 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 across standard pharmacy and mail order channels. For higher-tier medications, Tier 4 non-preferred drugs have a 45% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus Giveback H1036-323 (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care, preventive services, and home health care. Specialist visits require a $45 copay, while emergency room visits have a $115 copay that is waived upon hospital admission. For inpatient hospital stays, members pay a $489 daily copay for days one through five, with no copay for subsequent days. In addition to core medical care, this plan provides valuable supplemental benefits including routine dental and vision care with no copay. Routine hearing exams also feature no copay, while prescription hearing aids require a copay of $599 to $899. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus Giveback H1036-323 (HMO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $489 daily copay for days 1 to 5 (with no copay for days 6 and beyond), and psychiatric care requires a $416 daily copay for days 1 to 5 (with no copay for days 6 to 90), while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H1036-323 (HMO) covers outpatient services with no coinsurance, featuring a copay of $0 to $489 for outpatient hospital services and $489 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 have no coinsurance and a copay ranging from $0 to $35.
Partial Hospitalization See details
Humana Gold Plus Giveback H1036-323 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services are covered by the Humana Gold Plus Giveback H1036-323 (HMO) with no coinsurance, requiring a $335.00 copay for ground ambulance and a $1250.00 copay for air ambulance, both of which require prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus Giveback H1036-323 (HMO) covers emergency services with a $115 copay and no coinsurance, with the copay 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 H1036-323 (HMO) covers primary care, mental health, and psychiatric services with no copay and no coinsurance. Specialist visits require a $45 copay, physical and occupational therapy require a $35 copay, and telehealth ranges from no copay to a $45 copay, all with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus Giveback H1036-323 (HMO) covers preventive services—including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training—with no copay and no coinsurance. Additional preventive benefits are partially covered, offering a memory fitness program with no copay or coinsurance, but excluding services such as health education, nutritional therapy, and in-home safety assessments.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus Giveback H1036-323 (HMO), offering Medicare-covered exams for a $45 copay, alongside routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are covered for a $599 to $899 copay and no coinsurance with a limit of two per year, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Humana Gold Plus Giveback H1036-323 (HMO) with no copay, no coinsurance, and no deductible for routine eye exams and select eyewear, though prior authorization is required. This partially covered benefit offers up to a $250 annual maximum for contact lenses or complete eyeglasses, but excludes other eye exam services, individual eyeglass lenses or frames, and upgrades.
Dental Services See details
Humana Gold Plus Giveback H1036-323 (HMO) partially covers dental services, offering Medicare-covered dental with a $45 copay and no coinsurance, and most other preventive and comprehensive dental services with no copay and no coinsurance up to a $1,000 annual maximum. While many services like exams, cleanings, and x-rays are covered, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H1036-323 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus Giveback H1036-323 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Humana Gold Plus Giveback H1036-323 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, subject to prior authorization. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus Giveback H1036-323 (HMO) with prior authorization required. Diagnostic procedures and tests have no coinsurance and a copay of $0 to $45, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Humana Gold Plus Giveback H1036-323 (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus Giveback H1036-323 (HMO) requires prior authorization and features no coinsurance for Cardiac Rehabilitation Services, but in practice only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H1036-323 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required. There is no copay for days 1 to 20 and days 66 to 100, a $218 daily copay for days 21 to 65, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus Giveback H1036-323 (HMO) partially covers other services, including acupuncture with a $45 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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