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Humana Gold Plus H1036-333 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-333 (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 H1036-333 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-333 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Richmond-Tidewater Area. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H1036-333 (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 H1036-333 (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 H1036-333 (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. 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 $350.00 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 $4900.00 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 H1036-333 (HMO) Medicare plan features a $350 annual drug deductible. For Tier 1 preferred generics, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generics are also highly affordable, costing as little as a $5 copay for a 1-month supply, or 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 across most pharmacy and mail-order options. Higher-tier drugs shift to coinsurance, with Tier 4 non-preferred drugs requiring a 43% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance. These structured drug copays and coinsurance rates help you easily plan your prescription drug costs with the Humana Gold Plus H1036-333 (HMO) plan.
Additional Benefits
The Humana Gold Plus H1036-333 (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive screenings, routine eye and hearing exams, and most dental services. Members also benefit from no copays on home health care and select outpatient procedures, while specialist visits require a low $10 copay. These everyday health services are designed to keep out-of-pocket costs predictable with no coinsurance required for most routine care. For more intensive medical needs, inpatient hospital stays carry a daily copay of $345 for the first several days before dropping to no copay, while emergency room visits have a flat $130 copay. Specialized services like dialysis and durable medical equipment require a 20% coinsurance, while prescription hearing aids require copays starting at $499. This plan balances robust routine coverage with structured, predictable copays for emergency and inpatient care.
Inpatient Hospital See details
Humana Gold Plus H1036-333 (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $345 daily copay for days 1 to 8 and no copay for days 9 and beyond, while psychiatric stays require a $345 daily copay for days 1 to 6 and no copay for days 7 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H1036-333 (HMO) outpatient services are covered with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $345 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H1036-333 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Humana Gold Plus H1036-333 (HMO), as transportation to plan-approved or any health-related locations is not covered. Medicare-covered ground and air ambulance services require prior authorization and have a $335 copay per service with no coinsurance.
Emergency Services See details
Humana Gold Plus H1036-333 (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 each carry a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-333 (HMO) covers primary care visits with no copay and no coinsurance, and specialist visits with a $10 copay and no coinsurance. Physical, occupational, and speech therapies require a $25 copay with no coinsurance, while mental health services have a $35 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H1036-333 (HMO) covers key preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and a memory fitness benefit, with no copay and no coinsurance. However, other supplemental preventive services such as health education, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
Humana Gold Plus H1036-333 (HMO) covers routine hearing exams and fittings with no copay and no coinsurance, and Medicare-covered exams for a $10 copay and no coinsurance. Unlimited OTC hearing aids are covered with no copay and no coinsurance, while prescription hearing aids are partially covered with a $499 to $1,099 copay and no coinsurance, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Humana Gold Plus H1036-333 (HMO) offers partially covered vision services with no coinsurance, no deductibles, and prior authorization required. There is no copay for one routine eye exam per year and up to $350 annually for one pair of contact lenses or eyeglasses (lenses and frames), while other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-333 (HMO) partially covers dental services with an annual maximum benefit of $3,000, featuring no copay and no coinsurance for most preventive and comprehensive services, and a $10 copay with no coinsurance for Medicare-covered dental. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H1036-333 (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this plan, Medicare Part B insulin has a $35 copay and 0% to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus H1036-333 (HMO) plan with a $30 copayment and 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H1036-333 (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, whereas diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-333 (HMO) covers diagnostic and radiological services with prior authorization, offering no copay and no coinsurance for lab services and outpatient X-rays. Diagnostic procedures feature no coinsurance and a copay up to $120, while therapeutic radiology requires a minimum $10 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus H1036-333 (HMO) covers home health services with no copay and no coinsurance. Prior authorization is required to access these covered services.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-333 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-333 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copayment for days 1 through 20 and a $218 daily copayment for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Humana Gold Plus H1036-333 (HMO) covers acupuncture with a $10.00 copay and no coinsurance for up to 20 treatments per year, as well as over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Dual Eligible SNPs and other additional services are not covered under this plan benefit.
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