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Humana Gold Plus SNP-DE H1036-331 (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 H1036-331 (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 H1036-331 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in North Carolina. 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 H1036-331 (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 H1036-331 (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 H1036-331 (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 H1036-331 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.00. 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:
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Drug Coverage
The Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using standard pharmacies or preferred mail order for both 1-month and 3-month supplies. If you choose standard mail order, Tier 1 drugs require a $10 copay for a 1-month supply ($30 for 3 months), while Tier 2 drugs carry a $20 copay ($60 for 3 months). For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance rate remains the same whether you use standard pharmacies, preferred mail order, or standard mail order.
Additional Benefits
The Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) plan offers comprehensive coverage with a focus on minimizing out-of-pocket costs for essential healthcare. Many routine services, including primary care, outpatient hospital services, and dialysis, feature no copay alongside a 20% coinsurance. Additionally, beneficiaries can access preventive care, home health services, and the first 20 days of skilled nursing facility stays with no copay and no coinsurance. For specialized care, the plan provides robust dental benefits with no copay or coinsurance up to a $4,000 annual limit, alongside a $350 annual allowance for eyewear. While inpatient hospital stays require flat copays of $2,230 for acute care and $2,080 for psychiatric care per stay, they feature no coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H1036-331 (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. While unlimited additional acute care days are covered with no copay, non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H1036-331 (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 these covered services, and the blood services deductible is waived for the first three pints.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Additional transportation services, including trips to plan-approved or any health-related locations, are not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H1036-331 (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 require a 20% coinsurance (up to $40) 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 under the Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) are covered with no copay and a 20% coinsurance, though prior authorization is required for most specialist, therapy, and psychiatric services. Chiropractic services are partially covered, excluding routine and other chiropractic care, while podiatry services are not covered.
Preventive Services See details
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance for a memory fitness benefit, whereas health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) covers Medicare-covered hearing exams, fitting evaluations, and OTC hearing aids with no copays and no coinsurance, while routine hearing exams require a 20% coinsurance and no copay. 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 H1036-331 (HMO D-SNP), offering one routine eye exam per year with no copay and a 20% coinsurance. Covered eyewear has no copay, no coinsurance, and a $350 annual limit for one pair of contact lenses or eyeglasses (lenses and frames) per year, though other eye exam services, upgrades, and standalone eyeglass lenses or frames are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) dental services are partially covered, offering preventive and comprehensive care with no copay and no coinsurance up to a $4,000 annual limit, while Medicare-covered dental services require a 20% coinsurance and no copay. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) covers home infusion bundled services with prior authorization, requiring no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered insulin carries a $35 copay with no coinsurance to 20% coinsurance, while other Part B drugs have no copay and chemotherapy drugs may require a copayment.
Dialysis Services See details
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus SNP-DE H1036-331 (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 H1036-331 (HMO D-SNP) covers diagnostic and radiological services with prior authorization, requiring 20% coinsurance across all services. Diagnostic tests and lab services have no copay, while outpatient X-rays require a $50 copay and diagnostic radiological services require a $200 copay.
Home Health Services See details
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) with no copay and require prior authorization, though some services are not covered. Specifically, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) covers other services including acupuncture with no copay and 20% coinsurance for up to 20 treatments per year, alongside over-the-counter items and chronic illness meals with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while highly integrated services and other miscellaneous services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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