A non-government entity
Humana Gold Plus SNP-DE H1036-324 (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 H1036-324 (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 H1036-324 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) is a HMO D-SNP 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 SNP-DE H1036-324 (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 H1036-324 (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 H1036-324 (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 H1036-324 (HMO D-SNP), 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 $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:
Sign up for Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 3 (Preferred Brand) drugs, there is no copay for 1-month and 3-month supplies filled at standard pharmacies or through preferred mail order. If you choose standard mail order for these tiers, 1-month copays range from $10 to $47, and 3-month copays range from $30 to $141. For Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) medications, you will pay a 25% coinsurance. This 25% coinsurance applies to 1-month and 3-month supplies of Tier 4 drugs, as well as 1-month supplies of Tier 5 drugs, whether filled at a standard pharmacy, preferred mail order, or standard mail order.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) plan offers comprehensive medical coverage, with many essential services requiring no copay and a 20% coinsurance, including primary care, outpatient services, and dialysis. Preventive care and home health services are fully covered with no copay or coinsurance, helping you manage your health at no extra cost. For hospital stays, the plan features a $2,230 copay per acute inpatient stay, while emergency visits have a $115 copay that is waived if you are admitted. This plan also includes valuable supplemental benefits like dental, vision, and hearing coverage to support your overall well-being. Dental services are covered up to a $3,500 annual limit with no copay or coinsurance, while routine vision and hearing exams are available with no copay and a 20% coinsurance. Additionally, members can access over-the-counter items and up to 24 one-way transportation trips per year to plan-approved locations with no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by the Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) with no coinsurance, requiring a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay. Prior authorization is required, and while unlimited additional acute days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus SNP-DE H1036-324 (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 H1036-324 (HMO D-SNP) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) 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 are covered with a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits for the Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) are covered with no copay and a 20% coinsurance, which applies to primary care, specialist visits, therapies, mental health, and telehealth services. Podiatry services and chiropractic care are not covered under this plan.
Preventive Services See details
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) offers preventive services with no copay and no coinsurance, including annual physicals, diabetes self-management, and kidney disease education. However, these benefits are partially covered, as the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access, safety devices, and counseling.
Hearing Services See details
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) hearing services are covered with no deductible, featuring routine exams for a 20% coinsurance and no copay, and fitting evaluations and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP), excluding other eye exam services, eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are available with no copay and a 20% coinsurance, and covered eyewear is offered with no copay, no coinsurance, and a $200 annual maximum limit.
Dental Services See details
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and a 20% coinsurance, plus other dental benefits up to a $3,500 annual limit with no copay or coinsurance. Covered services include exams, cleanings, and extractions, while fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) subject to prior authorization and step therapy. Covered Part B drugs, including chemotherapy and insulin, require coinsurance ranging from no coinsurance up to 20%, with insulin having a $35 copay and other Part B drugs requiring no copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus SNP-DE H1036-324 (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
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) covers diagnostic and radiological services, with prior authorization required. Outpatient diagnostic tests and lab services have no copay and a 20% coinsurance, while radiological and outpatient X-ray services require a 20% coinsurance, with diagnostic radiology also carrying a $200 copay.
Home Health Services See details
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to access these fully covered services.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) covers some cardiac rehabilitation services with no copay and required prior authorization, although several key sub-services are not covered in practice. Specifically, standard cardiac rehabilitation and intensive cardiac rehabilitation are not covered and carry a 20% coinsurance, while pulmonary rehabilitation and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry an 8% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1–20 and 66–100, and a $218 daily copay for days 21–65. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) covers acupuncture with no copay and 20% coinsurance for up to 20 treatments per year, subject to prior authorization. The plan also covers over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, though prior authorization is required for the meal benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved