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Humana Gold Plus H3533-035 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H3533-035 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H3533-035 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H3533-035 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in 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 H3533-035 (HMO) 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 H3533-035 (HMO).
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 H3533-035 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.60. 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 $400.00 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 H3533-035 (HMO) plan has a $400 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for a preferred generic drug, you will pay a $12 copay at a standard pharmacy or preferred mail order, and a $20 copay at a standard mail order pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H3533-035 (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with copays, outpatient services with varying copays, and emergency services with a $110 copay. Primary care services are covered with no copay for many services, and preventive services are available with no copay. Additional benefits include hearing exams with a copay and no copay for routine exams, vision services with a copay for exams and no copay for eyewear, and dental services with a copay for Medicare services and no copay for other services. The plan also covers home health services with no copay, skilled nursing facility stays with copays, and other services such as acupuncture and a meal benefit with a copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric services. For acute inpatient hospital stays, you will pay a $340 copay for days 1-7, and no copay for days 8-90, while psychiatric stays have a $270 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $40 and $1100, observation services with a $340 copay, ambulatory surgical center services with a $275 copay, and outpatient substance abuse services with a copay between $45 and $90 for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H3533-035 (HMO) plan. The plan has a $55 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H3533-035 (HMO) plan. Ground and Air Ambulance Services have a $315 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H3533-035 (HMO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay.
Primary Care See details
The Humana Gold Plus H3533-035 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $30 copay. Physician specialist services have a $45 copay, and mental health specialty services have a $45 copay. The plan also covers physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a copay between $45 and $90.
Preventive Services See details
Preventive Services include Medicare-covered zero-dollar preventive services and an annual physical exam with no copay, as well as kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a Welcome Visit, all with no copay. However, health education, in-home safety assessments, personal emergency response systems, and many other additional preventive services are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, while routine hearing exams have no copay for one visit per year, and fitting/evaluation for hearing aids also have no copay. Prescription hearing aids are covered, with a copay between $399 and $699 for all types, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered; OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H3533-035 (HMO) plan covers vision services, including eye exams with a copay of $0-$45 and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H3533-035 (HMO) covers Medicare Dental Services with a $45 copay, and other dental services with no copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay, while fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services and prosthodontics, fixed have a 30% - 40% coinsurance and no copay, while adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery have no copay.
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, with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 8% coinsurance, Prosthetics/Medical Supplies - Non-Medicare benefit with a coinsurance for Medicare-covered items, and Diabetic Equipment with varying copays and coinsurance based on the specific service. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $100, and lab services with no copay. Diagnostic radiological services have a copay between $45 and $720, while therapeutic radiological services have 20% coinsurance. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H3533-035 (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus H3533-035 (HMO) plan. Prior authorization is required for these services, but the plan does not cover the services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H3533-035 (HMO) plan covers acupuncture with a $45 copay and a limit of 20 treatments per year, and also covers a meal benefit with no copay. Other services such as over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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