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Humana Gold Plus SNP-DE H1036-325 (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 H1036-325 (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 H1036-325 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-325 (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 H1036-325 (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 H1036-325 (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 H1036-325 (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 H1036-325 (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. 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 $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 H1036-325 (HMO D-SNP) Medicare plan has an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay when filled through standard pharmacies or preferred mail order for 1-month or 3-month supplies. If you choose standard mail order, Tier 1 drugs require a $10 copay for 1-month and $30 copay for 3-month supplies, while Tier 2 drugs cost a $20 copay for 1-month and $60 copay for 3-month supplies. For higher-tier medications, the plan charges a flat coinsurance rate instead of a copayment. Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all require a 25% coinsurance. This 25% coinsurance applies across standard pharmacies, preferred mail order, and standard mail order for all available supply durations.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) offers comprehensive medical coverage, featuring no copays for primary care, specialist visits, and outpatient services, which generally require a 20% coinsurance. Inpatient hospital stays require a copay of $2,230 per stay for acute care with no coinsurance, while emergency room visits have a $115 copay that is waived if you are admitted. Routine home health services are available with no copays and no coinsurance, and skilled nursing facility stays offer no copays for the first 20 days. This plan also provides robust additional benefits, including preventive and comprehensive dental care with no copay and no coinsurance up to a $4,000 annual limit. Vision and hearing benefits feature no copays for routine eyewear up to a $250 yearly limit and prescription hearing aids, while routine eye exams carry a 20% coinsurance. Additionally, members can access up to 24 one-way transportation trips per year and over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Non-Medicare-covered stays, room upgrades, and additional psychiatric care days are not covered under this plan, though unlimited additional acute care days are covered with no copay.
Outpatient Services See details
Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H1036-325 (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. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H1036-325 (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 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
Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) covers primary care, specialist, telehealth, and therapy services with no copay and a 20% coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) features partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and select fitness and tobacco cessation counseling. Non-covered services include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission 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, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) covers hearing services with no deductible, offering Medicare-covered exams, fitting evaluations, and OTC hearing aids with no copays and no coinsurance. Routine hearing exams are covered once per year with a 20% coinsurance and no copay, and prescription hearing aids are partially covered with no copay and no coinsurance for up to two devices every three years, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Vision Services are partially covered by Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP), providing one annual routine eye exam with no copay and 20% coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $250 yearly limit for contact lenses or eyeglasses (lenses and frames), but individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) features partially covered dental services, providing Medicare-covered dental with no copay and 20% coinsurance, alongside other covered preventive and comprehensive dental services with no copay, no coinsurance, and a $4,000 annual maximum. However, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) covers home infusion bundled services, which require prior authorization and step therapy. Medicare Part B insulin drugs have a $35 copay and 0% to 20% coinsurance, other Part B drugs feature no copay and 0% to 20% coinsurance, and chemotherapy drugs require a copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. 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 H1036-325 (HMO D-SNP) and require prior authorization, with a 20% coinsurance applying to all services. There is no copay for lab services, outpatient X-rays, and diagnostic procedures, while diagnostic radiological services require a $200 copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) with no copay, though some services are covered while key sub-services are not covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a 15% to 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. 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 100-day Medicare benefit period are not covered.
Other Services See details
Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) covers other services with no copay and no coinsurance, including acupuncture limited to 25 treatments per year, over-the-counter items, and meals for chronic illnesses. This benefit is partially covered, as highly integrated services for dual-eligible SNPs and other miscellaneous services are not covered.
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