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Humana Gold Plus H1036-327 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-327 (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 H1036-327 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-327 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Central and Northwest Mississippi. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H1036-327 (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 H1036-327 (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 H1036-327 (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 $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 $5700.00 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 H1036-327 (HMO) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, members benefit from no copay for 1-month and 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies, but members pay no copay for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with a discounted $131 copay for a 3-month supply through preferred mail order. For higher-tier medications, members pay a percentage of the drug cost, which includes 50% coinsurance for Tier 4 non-preferred drugs and 25% coinsurance for Tier 5 specialty drugs. This structured pricing allows beneficiaries to optimize their Medicare drug coverage costs by utilizing preferred mail-order services.
Additional Benefits
The Humana Gold Plus H1036-327 (HMO) plan offers comprehensive coverage with many everyday health services available at low or no cost. Members enjoy no copay for primary care physician visits, routine hearing and vision exams, home health services, and preventive dental care up to a $2,500 annual limit. Routine vision benefits also include up to $250 annually for contacts or eyeglasses with no copay. For specialized care, the plan features a $25 copay for specialist visits and a $295 daily copay for the first seven days of inpatient hospital stays. Outpatient services are affordable, with no copay for ambulatory surgical center visits and a $130 copay for emergency room visits, which is waived if you are admitted. Durable medical equipment and dialysis services are covered with a standard 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H1036-327 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a daily copay of $295 for days 1 through 7 and no copay for days 8 through 90. Unlimited additional acute care days are covered with no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H1036-327 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $225 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Gold Plus H1036-327 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-327 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H1036-327 (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 are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-327 (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits and physical, occupational, or speech therapies require a $25 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $35 copay with no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Humana Gold Plus H1036-327 (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, diabetes self-management training, and fitness benefits. Additional preventive services are only partially covered, with excluded services including health education, weight management, in-home safety assessments, and medical nutrition therapy.
Hearing Services See details
Humana Gold Plus H1036-327 (HMO) covers hearing services, featuring a $25 copay and no coinsurance for Medicare-covered exams, and routine exams and hearing aid fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 (limit of two per year), though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Humana Gold Plus H1036-327 (HMO) partially covers vision services with no deductibles, no copays, and no coinsurance, including one routine eye exam and up to $250 yearly for contact lenses or eyeglasses (lenses and frames). Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-327 (HMO) partially covers dental services, offering Medicare-covered dental care with a $25 copay and no coinsurance. Other covered diagnostic, preventive, and comprehensive dental services feature no copay and no coinsurance up to a $2,500 annual limit, though fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-327 (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H1036-327 (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus H1036-327 (HMO) covers durable medical equipment, prosthetics, and medical supplies 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 applicable coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-327 (HMO) covers diagnostic and radiological services under prior authorization, offering lab services with no copay and no coinsurance, and diagnostic tests with a $0 to $50 copay and no coinsurance. Therapeutic radiological services require a $25 copay and a minimum 20% coinsurance, while outpatient X-rays have no copay but do require coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H1036-327 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus H1036-327 (HMO) plan with no coinsurance and required prior authorization. While some services are covered, specific sub-services including 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) care is covered by Humana Gold Plus H1036-327 (HMO) with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H1036-327 (HMO) provides partial coverage for other services, featuring acupuncture for a $25 copay and no coinsurance up to 20 treatments per year, alongside chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items and other supplemental services are not covered.
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