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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 you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. You will enter the next coverage phase once your total drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). With LIS, you will pay $69.90 for Part D. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Hospital stays have copays, while outpatient services, including doctor visits and specialist visits, typically involve a 20% coinsurance. The plan covers emergency services, ambulance, and transportation, and also includes coverage for vision, dental, and hearing services. Preventive services, annual physical exams, and many other services have no copay. The plan also offers coverage for home health, skilled nursing facilities, and medical equipment, but some of these services may require prior authorization and have associated copays or coinsurance. Additionally, the plan provides coverage for over-the-counter items, and meals.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric services, are covered with prior authorization required. For Inpatient Hospital-Acute, there is a copay of $2,185 per admission, and for Inpatient Hospital Psychiatric, there is a copay of $2,036 per admission; additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute, as well as additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric, 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, Ambulatory Surgical Center (ASC) Services with a $200 copay and 20% coinsurance, Outpatient Substance Abuse Services with 20% coinsurance, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan and requires prior authorization. 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. Ground and air ambulance services have a $315 copay, while transportation services to a plan-approved health-related location have no copay, with a limit of 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under this plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services has 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, including Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, with a 20% coinsurance for most services. Routine Chiropractic Care and Podiatry Services are not covered. Additional Telehealth Benefits have a copay of $0-$45.
Preventive Services See details
Preventive services include Medicare-covered preventive services, annual physical exams, kidney disease education services, and other preventive services. Annual physical exams have no copay, and Glaucoma screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following the Welcome Visit also have no copay. Some additional preventive services, including Health Education, In-Home Safety Assessment, and others, 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% for routine hearing exams and no deductible, while fitting/evaluation for hearing aids has no copay. Prescription hearing aids have a $2,000 maximum benefit per year, and OTC hearing aids have a $0 copay with a maximum benefit of $2,040 per year.
Vision Services See details
Vision Services include coverage for eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance. Routine eye exams have no copay, and contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. Other Dental Services include 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, all with no copay, but some services have visit limits. Periodontics, maxillofacial prosthetics, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0-20%, while Other Medicare Part B Drugs have no copay and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 20% coinsurance and no copay. Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests and lab services have a coinsurance of at most 20%, with a copay of up to $45 for diagnostic procedures/tests and no copay for lab services. Diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of at most 20%, with a copay of up to $325 for diagnostic radiological services and $45 for outpatient X-ray services.
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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under 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 per day; this plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays.
Other Services See details
The Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP) plan covers acupuncture with a 20% coinsurance after prior authorization, and also covers over-the-counter (OTC) items with a maximum benefit coverage amount of $40.00 every month, and meals with no copay after prior authorization. Other services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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