A non-government entity
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 2026, 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 2026.
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 $22.00. 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:
Sign up for Humana Gold Plus H3533-035 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H3533-035 (HMO) prescription drug plan features an annual deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, with a $5 copay for a one-month supply at standard pharmacies, and no copay for a three-month supply ordered through preferred mail order. For brand-name and higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply. Tier 4 non-preferred drugs carry a 33% coinsurance for both one-month and three-month supplies. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Humana Gold Plus H3533-035 (HMO) plan offers comprehensive coverage for core medical services, featuring no copay and no coinsurance for primary care, telehealth, and preventive visits. Specialist consultations require a copay of $30 to $35, while inpatient hospital stays carry a daily copay of $340 for the first seven days of acute care with no coinsurance. Emergency care is accessible with a $115 copay, which is waived upon hospital admission, and urgent care visits require a $40 copay. This plan also includes valuable supplemental benefits, providing routine hearing exams, over-the-counter hearing aids, annual eye exams, and preventive dental care with no copays and no coinsurance. Prescription hearing aids feature copays ranging from $399 to $699, while select comprehensive dental services are covered up to a $3,000 annual limit with 30% to 40% coinsurance. Additionally, home health services require no copay, while durable medical equipment and dialysis services are subject to a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H3533-035 (HMO) covers inpatient hospital services with no coinsurance, requiring a $340 daily copay for days 1-7 of acute stays and a $270 daily copay for days 1-7 of psychiatric stays, followed by no copay for remaining days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H3533-035 (HMO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay between $0 and $850, observation services require a $340 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H3533-035 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services under Humana Gold Plus H3533-035 (HMO) are partially covered, with both ground and air ambulance services requiring a $335 copay and no coinsurance. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H3533-035 (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all available with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H3533-035 (HMO) offers primary care services and telehealth benefits with no coinsurance and copays starting at $0. Specialist visits, mental health, psychiatric, and therapy services require copays of $30 to $35 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H3533-035 (HMO) offers partially covered preventive services with no copay and no coinsurance for services such as annual physical exams, kidney disease education, and diabetes self-management training. However, additional preventive services including fitness benefits, health education, and personal emergency response systems are not covered.
Hearing Services See details
Humana Gold Plus H3533-035 (HMO) covers Medicare-covered hearing exams for a $35 copay and routine exams and fittings with no copay, all with no coinsurance. Prescription hearing aids are partially covered with copays ranging from $399 to $699 and no coinsurance, though inner ear, outer ear, and over-the-ear models are not covered. Over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H3533-035 (HMO) offers partially covered vision services with no copay, no coinsurance, and no deductible for annual routine eye exams and select eyewear, up to a $200 yearly limit. While routine exams, contact lenses, and complete eyeglasses (lenses and frames) are covered, other eye exam services, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H3533-035 (HMO) offers partially covered dental services up to a $3,000 annual limit, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and select comprehensive services. Other comprehensive services require no copay and 30% to 40% coinsurance, though fluoride, implants, orthodontics, maxillofacial prosthetics, and removable prosthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H3533-035 (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance, while covered Part B insulin drugs carry a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H3533-035 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to obtain these services.
Medical Equipment See details
Humana Gold Plus H3533-035 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Covered diabetic supplies carry a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H3533-035 (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $100 copay for diagnostic procedures, while radiological services feature no copay for outpatient X-rays and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H3533-035 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H3533-035 (HMO) plan, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H3533-035 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior 3-day hospital stay. There is no copay for days 1 through 20 and a $218 copay per day for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H3533-035 (HMO) partially covers other services, offering acupuncture with a $35 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services and other additional services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved