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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 2025, 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 2025.
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 $69.90. 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 $590.00 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 $9350.00 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) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you have LIS, you will pay $69.90 per month for Part D.
Additional Benefits
The Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services with varying copays and coinsurance. This plan includes coverage for emergency services, primary care, preventive services, hearing, vision, dental, and home health services. Many services have no copay, such as annual physical exams, prescription hearing aids, and routine eye exams, while others have coinsurance, such as specialist visits and dental services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with prior authorization. For acute care, there is a copay of $2,185 per admission or stay, and additional days are covered with no copay. For psychiatric care, there is a copay of $2,036 per admission or stay, but additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a $250 copay and 20% coinsurance, observation services with a $500 copay, and ambulatory surgical center (ASC) services with a $200 copay and 20% coinsurance. Outpatient substance abuse services, including individual and group sessions, are covered with 20% coinsurance. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered under this plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $315 copay. Transportation Services to a plan-approved health-related location are covered, with 12 one-way trips per year and no copay, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all have no coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) plan covers primary care services with 20% coinsurance, chiropractic services with 20% coinsurance, and occupational therapy services with 20% coinsurance. The plan also covers physician specialist services, mental health specialty services, psychiatric services, physical therapy, speech-language pathology services, and telehealth with 20% coinsurance, while podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams with no copay, and kidney disease education services with no copay. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are covered with no copay, while health education, in-home safety assessments, and other services are not covered.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% and a copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids have no copay, and OTC hearing aids have no copay.
Vision Services See details
Vision services include eye exams with 20% coinsurance and no copay, and eyewear benefits with 20% coinsurance and a copay for eyeglasses (lenses and frames). This plan covers routine eye exams with no copay, contact lenses with no copay, and eyeglasses (lenses and frames) with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with specific services having a 20% coinsurance. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, prosthodontics (removable), implant services, and oral and maxillofacial surgery are covered with no copay, but some services are limited to a certain number of visits per year or lifetime. Periodontics, maxillofacial prosthetics, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B drugs with 0-20% coinsurance and no copay. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered under the Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Diabetic Supplies has a 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, lab services, and radiological services. Diagnostic procedures/tests have a coinsurance of at most 20% and a copay of at most $45, while lab services have a coinsurance of at most 20% and no copay. Diagnostic radiological services and therapeutic radiological services have a coinsurance of at most 20%, and diagnostic radiological services have a copay of at most $325. Outpatient X-ray services have a coinsurance of at most 20% and a copay of $45.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) plan covers acupuncture with a 20% coinsurance, and also includes an over-the-counter (OTC) items benefit of $40 per month. This plan also offers a meal benefit with no copay, and covers meals for chronic illnesses. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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