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Humana Gold Plus H1036-335 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H1036-335 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H1036-335 (HMO-POS) in 2026, please refer to our full plan details page.
Humana Gold Plus H1036-335 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2026 to people living in Select counties 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 H1036-335 (HMO-POS) 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 H1036-335 (HMO-POS).
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 H1036-335 (HMO-POS), 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 $250.00 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 $3500.00 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 H1036-335 (HMO-POS) prescription drug plan has an annual drug deductible of $250. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost $5 for a 1-month supply at standard pharmacies, and you can get a 3-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, or up to $141 for a 3-month supply. For higher-tier medications, Tier 4 non-preferred drugs carry a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance.
Additional Benefits
The Humana Gold Plus H1036-335 (HMO-POS) plan offers robust medical coverage with affordable out-of-pocket costs, including no copays for primary care visits and a low $5 copay for specialists. Inpatient hospital stays require a $295 daily copay for days one through five, followed by no copay for days six through 90. Emergency services are available with a $150 copay, which is waived upon hospital admission, while urgent care visits require a $65 copay. Members also benefit from dental coverage up to a $2,500 annual limit and routine vision exams with a $250 eyewear allowance, both featuring no copays. Routine hearing exams and fitting evaluations are also covered with no copay, while prescription hearing aids require copays between $499 and $799. Standard medical equipment, prosthetics, and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H1036-335 (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $295 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are covered with no copay.
Outpatient Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $395 for outpatient hospital services and $295 per stay for observation services. Outpatient substance abuse sessions have a $35 copay, while ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H1036-335 (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are available with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H1036-335 (HMO-POS) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $5 copay and no coinsurance. Therapy services carry a $25 copay, mental health sessions cost a $35 copay, and telehealth ranges from no copay up to a $65 copay—all with no coinsurance—while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive services are partially covered, offering a memory fitness benefit with no copay and no coinsurance, while health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers hearing services with no coinsurance, featuring a $5 copay for Medicare-covered exams and no copay for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with a copay of $499 to $799 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H1036-335 (HMO-POS) provides partially covered vision services with no coinsurance, requiring prior authorization. Routine eye exams are covered with no copay (one per year), but other eye exams are not covered. Covered eyewear includes one pair of contact lenses or eyeglasses (lenses and frames) per year with no copay up to a $250 limit, while separate eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-335 (HMO-POS) partially covers dental services up to a $2,500 annual maximum, featuring a $5 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Gold Plus H1036-335 (HMO-POS) with no copay, though prior authorization and step therapy may apply. Covered Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while covered Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required before you can receive these covered services.
Medical Equipment See details
Humana Gold Plus H1036-335 (HMO-POS) covers medical equipment, including durable medical equipment (DME), 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, with prior authorization required.
Diagnostic and Radiological Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers diagnostic and radiological services, requiring prior authorization for both. Outpatient diagnostic procedures feature no coinsurance with copays ranging from $0 to $120, while lab services, outpatient X-rays, and diagnostic radiology have no copays, and therapeutic radiology requires a minimum 20% coinsurance and a $5 minimum copay.
Home Health Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus H1036-335 (HMO-POS) plan with no copay, no coinsurance, and a prior authorization requirement. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H1036-335 (HMO-POS) covers up to 100 days of Skilled Nursing Facility (SNF) care with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus H1036-335 (HMO-POS) provides partial coverage for other services, featuring acupuncture for a $5.00 copay and no coinsurance, alongside meal benefits and over-the-counter (OTC) items with no copay and no coinsurance. However, Dual Eligible SNPs with Highly Integrated Services and additional miscellaneous services (Other 1, 2, and 3) are not covered.
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