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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 $2.00. 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 $3950.00 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 features an annual drug deductible of $250. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, with standard pharmacy copays starting at $5 for a 1-month supply and no copay for a 3-month supply when filled through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail-order services. For higher-tier medications, Tier 4 non-preferred drugs carry a 50% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply through standard pharmacies and mail-order options.
Additional Benefits
The Humana Gold Plus H1036-335 (HMO-POS) plan offers robust medical coverage, featuring no copay for primary care visits, preventive services, and home health care. Specialist visits require a low $10 copay, while inpatient hospital stays have a $295 daily copay for days one through five and no copay for subsequent days. Emergency room care is available with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. In addition to core medical care, members enjoy comprehensive dental, vision, and hearing benefits, including no copay for most routine services and up to a $2,500 annual maximum for dental care. Vision benefits provide no copay for eyewear up to a $250 yearly limit, while routine hearing exams and fitting evaluations also feature no copay. Durable medical equipment and diagnostic services are covered with no copay and up to 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H1036-335 (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute days are covered with no copay, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while individual and group outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H1036-335 (HMO-POS) 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 H1036-335 (HMO-POS) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers emergency services with a $150 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 $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all 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, and specialist visits for a $10 copay and no coinsurance. Physical, occupational, and speech therapy services require a $25 copay with no coinsurance, while podiatry and routine chiropractic care are not covered.
Preventive Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and a memory fitness benefit. However, the plan only partially covers additional preventive services, excluding options such as health education, weight management programs, and in-home safety assessments.
Hearing Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers Medicare-covered hearing exams for a $10 copay and no coinsurance, while routine exams, fitting evaluations, and OTC hearing aids are available with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Gold Plus H1036-335 (HMO-POS) partially covers vision services with no coinsurance, featuring eye exams with a $0 to $10 copay and eyewear with no copay up to a $250 annual maximum. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, while other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H1036-335 (HMO-POS) dental services are partially covered up to a $2,500 annual maximum, featuring a $10 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most preventive and comprehensive services. Fluoride treatment, 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 is required. Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a 0% to 20% coinsurance, with insulin specifically requiring a $35 copay and no deductible.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H1036-335 (HMO-POS) with a $30 copayment and 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H1036-335 (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no copay and 10% to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H1036-335 (HMO-POS) with prior authorization required. Diagnostic services have no coinsurance, featuring no copay for lab services and a $0 to $120 copay for procedures, while radiological services range from no copay for diagnostic radiology and outpatient X-rays to a minimum $10 copay and 20% coinsurance for therapeutic services.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H1036-335 (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H1036-335 (HMO-POS) with no coinsurance, although prior authorization is required and additional days beyond the Medicare-covered limit are not covered. Members will pay a $20 copayment for days 1 through 20 and a $218 copayment for days 21 through 100, with no prior three-day hospital stay required.
Other Services See details
Humana Gold Plus H1036-335 (HMO-POS) covers acupuncture with a $10.00 copay and no coinsurance for up to 20 treatments per year, and meal benefits are covered with no copay and no coinsurance, both requiring prior authorization. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance, as some drugs on the CMS OTC list are not covered.
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