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Humana Gold Plus SNP-DE H1036-326 (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 H1036-326 (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 H1036-326 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-326 (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 H1036-326 (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 H1036-326 (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 H1036-326 (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 H1036-326 (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 H1036-326 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will enjoy no copay for one-month or three-month supplies filled at standard pharmacies or through preferred mail order. If you choose standard mail order for these generic tiers, Tier 1 drugs carry a $10 to $30 copay, while Tier 2 drugs require a $20 to $60 copay. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan charges a consistent 25% coinsurance rate. This coinsurance applies whether you fill your prescriptions at a standard pharmacy, through preferred mail order, or via standard mail order.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) plan offers comprehensive medical coverage, though cost-sharing details vary by service. For inpatient hospital stays, members pay a copayment of $2,230 per acute stay and $2,080 per psychiatric stay with no coinsurance. Routine primary care, specialist visits, outpatient hospital services, and diagnostic tests generally require a 20% coinsurance and no copay, while preventive care and home health services are available with no copay and no coinsurance. This plan also includes key supplemental benefits, such as dental care with no copay or coinsurance up to a $3,000 annual limit, and eyewear coverage with no copay or coinsurance up to $250 yearly. Routine hearing and vision exams feature a 20% coinsurance and no copay, while transportation provides up to 26 one-way trips per year with no copay and no coinsurance. Additionally, skilled nursing facility stays require no copay for days 1 to 20, but carry a $218 daily copay for days 21 to 65.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) covers inpatient acute hospital stays with a $2,230 copayment per stay and psychiatric stays with a $2,080 copayment per stay, both featuring no coinsurance. While unlimited additional acute care days are covered with no copayment, this plan does not cover upgrades, psychiatric additional days, or non-Medicare-covered stays.
Outpatient Services See details
Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) covers outpatient services with no copay and a 20% coinsurance for outpatient hospital visits, observation services, ambulatory surgical center services, substance abuse treatments, and blood services. Prior authorization is required for these covered services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) covers ground ambulance services with a $335 copay (coinsurance applies) and air ambulance services with a 20% coinsurance (copay applies), both requiring prior authorization. Transportation services are partially covered, providing up to 26 one-way trips per year to plan-approved locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H1036-326 (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 available with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) covers primary care, specialist, telehealth, and mental health 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 H1036-326 (HMO D-SNP) partially covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Several supplemental preventive services are not covered under this plan, including health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, and weight management programs.
Hearing Services See details
Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) covers hearing exams with no deductible, featuring routine exams with a 20% coinsurance and no copay, and Medicare-covered exams which require a copay. Fitting evaluations and OTC hearing aids are covered with no copay or coinsurance, while prescription hearing aids are partially covered with no copay or coinsurance, 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 H1036-326 (HMO D-SNP), offering one annual routine eye exam with no copay, 20% coinsurance, and no deductible. Covered eyewear, including contact lenses and eyeglasses (lenses and frames), features no copay, no coinsurance, and a $250 yearly limit, while other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP), featuring no copay and no coinsurance for most preventive and comprehensive care up to a $3,000 annual maximum, while Medicare-covered dental has no copay and a 20% coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) plan, requiring prior authorization and step therapy. Covered Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance, other Part B drugs have no copay and no coinsurance to 20% coinsurance, and chemotherapy drugs require a copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus SNP-DE H1036-326 (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 H1036-326 (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with 20% coinsurance and no copays. 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 H1036-326 (HMO D-SNP) covers diagnostic and radiological services, with prior authorization required for all care. Diagnostic procedures, tests, and lab services require a 20% coinsurance and no copay, while radiological and X-ray services carry a 20% coinsurance and copays, including a minimum $200 copay for diagnostic radiology.
Home Health Services See details
Humana Gold Plus SNP-DE H1036-326 (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 H1036-326 (HMO D-SNP) offers cardiac rehabilitation where some services are covered with no copay and prior authorization required. However, the plan does not cover standard cardiac rehabilitation (20% coinsurance), intensive cardiac rehabilitation (20% coinsurance), pulmonary rehabilitation (8% coinsurance), and supervised exercise therapy for peripheral artery disease (8% coinsurance).
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and 66 to 100, and a $218 daily copay for days 21 to 65. Prior authorization is required and a prior three-day hospital stay is not needed, though additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) covers other services including acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and certain highly integrated dual eligible services are not covered.
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* 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.
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