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Humana Gold Plus SNP-DE H3533-034 (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 H3533-034 (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 H3533-034 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Long Island and Select Counties in New York City. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus SNP-DE H3533-034 (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 H3533-034 (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 H3533-034 (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 H3533-034 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.10. 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 H3533-034 (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 for one-month or three-month supplies filled at standard retail pharmacies or through preferred mail-order services. If you choose standard mail-order, copays range from $10 to $30 for Tier 1 and $20 to $60 for Tier 2 drugs depending on the supply size. For brand-name and specialty medications, the plan transitions to a coinsurance structure. Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs all require a 25% coinsurance payment. This 25% coinsurance rate applies across standard pharmacies, preferred mail-order, and standard mail-order options.
Additional Benefits
The Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) offers robust medical coverage, featuring no copay and a 20% coinsurance for doctor visits, specialist consultations, and dialysis services. For hospital care, inpatient acute stays require a $2,230 copay and psychiatric stays require a $2,080 copay with no coinsurance, while home health services and preventive care are fully covered with no copay or coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted within 24 hours. Additionally, the plan provides valuable dental, vision, and hearing benefits to help manage your everyday healthcare costs. Members enjoy most dental services, including cleanings and exams, with no copay and no coinsurance, alongside OTC hearing aids and Medicare-covered hearing exams. Routine eye exams and up to $250 in annual eyewear are also covered with no copay, and skilled nursing facility care requires no copay for the first 20 days.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H3533-034 (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. Prior authorization is required, and while acute care includes unlimited additional days with no copay, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) covers outpatient services, including ambulatory surgical center services with no copay and no coinsurance. Outpatient hospital services require a $0 to $250 copay and 20% coinsurance, while outpatient substance abuse and blood services have no copay and 20% coinsurance, and observation services require 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to other health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care is available with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) covers primary care, specialist, mental health, psychiatric, therapy, and opioid treatment services with no copay and a 20% coinsurance. Additional telehealth benefits are covered with a $0.00 to $40.00 copay and 20% coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) offers partially covered preventive services, providing annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome visit EKGs with no copay and no coinsurance. Additional preventive benefits, including fitness benefits, health education, personal emergency response systems, and nutritional services, are not covered.
Hearing Services See details
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) covers hearing services with no deductible, offering Medicare-covered exams, fitting evaluations, and OTC hearing aids with no copays and no coinsurance. Routine hearing exams have no copay and a 20% coinsurance, and 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 models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP), featuring one annual routine eye exam with no copay and 20% coinsurance. Eyewear is covered up to $250 per year with no copay, but contact lenses require a 20% coinsurance, and other eye exams, individual lenses, frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 20% coinsurance. Most other preventive and comprehensive services, including exams, cleanings, fillings, implants, and oral surgery, feature no copay and no coinsurance, though orthodontics, periodontics, maxillofacial prosthetics, fixed prosthodontics, and other preventive services are not covered.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) covers home infusion bundled services under prior authorization, with covered chemotherapy and radiation drugs requiring a copayment and no coinsurance to 20% coinsurance. Covered Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance, while other Part B drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for this covered benefit.
Medical Equipment See details
Humana Gold Plus SNP-DE H3533-034 (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 H3533-034 (HMO D-SNP) covers diagnostic and radiological services, which require prior authorization and are subject to a 20% coinsurance. Outpatient X-rays require a $40 copay, diagnostic procedures and tests have a copay of up to $40, and lab services and diagnostic radiological services have no copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) with no copay and no coinsurance. Prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) covers some services under Cardiac Rehabilitation Services with no copay, though prior authorization is required. However, specific services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $218 copay per day for days 21 to 100. Prior authorization is required, and while a prior 3-day inpatient hospital stay is not needed for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) partially covers other services, providing acupuncture with no copay and 20% coinsurance for up to 20 treatments per year, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while highly integrated services and certain CMS OTC list drugs are not covered.
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