Humana Gold Plus SNP-DE H1036-167: Benefits, Costs, and Network

The Humana Gold Plus SNP-DE H1036-167 is a 2026 Dual Eligible Special Needs Plan (D-SNP) sold as an HMO in North Carolina for people enrolled in both Medicare and Medicaid. The monthly premium is $14.20, or $0 depending on the level of Extra Help the member receives, and the maximum out-of-pocket limit for covered Part A and Part B services is $9,250.¹ Most medical services carry a $0 copay, and the plan adds supplemental benefits that Original Medicare does not cover.

Who Can Enroll

To join, you must be entitled to both Medicare and Medicaid. The plan accepts members classified as Full Benefit Dual Eligible (FBDE), Qualified Medicare Beneficiary (QMB), QMB+, and SLMB+.² Humana holds a contract with the North Carolina Medicaid Division of Health Benefits to coordinate benefits across both programs.

If you are “Cost Share Protected,” federal rules bar providers from billing you for deductibles, coinsurance, or copayments on Medicare Part A and Part B services, even when the secondary Medicaid payment is zero. Bring both your North Carolina Medicaid ID card and your Humana membership card to every appointment.²

What You Pay

The premium is $14.20 per month, reduced for members with Extra Help. The plan is an HMO, so you choose an in-network primary care provider in the service area and generally use network doctors and hospitals.² Part D prescription coverage is Enhanced, with a $615 annual drug deductible that is waived for members receiving Extra Help.¹

Medical Services at $0 Copay

Primary care visits, specialist visits, and inpatient hospital stays all carry no cost sharing.¹ Skilled nursing facility stays are covered up to 100 days at $0 copay.²

Mental health care is also $0. Inpatient psychiatric care is covered up to the Medicare lifetime limit of 190 days, and outpatient mental health therapy carries no copay whether delivered at an outpatient hospital, in a specialist’s office, or by telehealth. Outpatient substance abuse services follow the same $0 structure.²

Telehealth visits for primary care, specialists, urgently needed services, mental health therapy, and outpatient substance abuse are offered at $0 in addition to Original Medicare-covered telehealth. The plan notes that telehealth is not a substitute for emergency care or a replacement for your primary care provider.²

Supplemental Benefits

Healthy Options Allowance

The Humana Healthy Options Allowance loads a monthly amount onto a prepaid spending card for approved over-the-counter health and wellness items. Members with certain qualifying chronic conditions can also use the card toward eligible groceries, utilities, and rent. Unused balances roll over month to month but expire at the end of the plan year or upon disenrollment.

Plan documents disagree on the amount: the Summary of Benefits published by the North Carolina Department of Insurance lists $225 per month,³ while a Summary of Benefits hosted on MedicareAdvantage.com lists $195 per month.⁴ Confirm the current allowance with Humana before relying on a specific figure.

Dental, Vision, and Hearing

Dental: up to $4,000 per year for diagnostic, preventive, and comprehensive services.
Vision: one routine eye exam per year at $0, plus a $250 annual allowance for eyeglasses or contact lenses. The allowance rises to $350 at a PLUS Provider in the Humana Medicare Insight Network.
Hearing: one routine hearing exam per year at $0, and one Advanced-level hearing aid per ear every three years at $0.⁴

Meals, Fitness, and a Transportation Gap

The Humana Well Dine program provides up to 14 home-delivered meals (two per day for seven days) after discharge from an inpatient hospital or nursing facility stay, at no cost. The benefit can be used up to four times per year, and meals must be requested within 30 days of discharge.⁴ Fitness is covered through SilverSneakers, and members can earn rewards through Go365 by Humana for completing preventive activities such as screenings and exams.³

Transportation is not a covered benefit under this plan.⁴ If you need rides to medical appointments, ask your Humana care coordinator whether North Carolina Medicaid can provide that transportation on the Medicaid side.

Care Coordination Across Medicare and Medicaid

Members have access to Humana Care Managers, who are nurses or care coordinators. Their work covers acute and chronic-care management, telephonic and in-person health guidance, help coordinating Medicare and Medicaid benefits, educational resources and workshops, and support for families and caregivers.³ The coordinator is also the person to ask about benefits Medicaid may pay for separately.

UNC Health Is Out of Network in 2026

Before enrolling, check where you get care. UNC Health terminated its contracts with Humana Medicare Advantage plans effective January 1, 2026, after it could not reach new agreements with Humana, WellCare, or Health Care Service Corporation (formerly Cigna). Members of the affected plans are considered out-of-network at all UNC Health facilities starting in 2026.⁵ In UNC Health’s High Country facilities alone, roughly 6,000 Humana patients had received care in the two years before the split.⁶

One exception: North Carolina State Health Plan retirees with Humana coverage may continue to see UNC Health providers at the same cost. UNC Health Blue Ridge president Gary Paxson said some Humana members received letters telling them to find new providers, but that message did not apply to State Health Plan retirees.⁷

How It Compares in North Carolina

H1036-167 is available in multiple North Carolina counties. In Davidson County, it sits among D-SNP offerings from Aetna, Alignment Health, BlueCross BlueShield of North Carolina, Cigna, Devoted Health, Liberty, UnitedHealthcare, and Wellcare. At $14.20 per month, it is one of the lower-priced plans in the market. Humana also sells other D-SNPs in the same area, including Humana Dual Select H1036-307 at $13.00 and Humana Gold Plus SNP-DE H1036-331 at $20.00.⁸ If your preferred doctors or hospitals are at UNC Health, compare carriers whose networks still include that system before you choose.

1
Medicare Advantage. Humana Gold Plus SNP-DE H1036-167 Evidence of Coverage
2
North Carolina Department of Insurance. Humana Gold Plus SNP-DE H1036-167 Summary of Benefits
3
North Carolina Department of Insurance. Humana Gold Plus SNP-DE H1036-167 Summary of Benefits
4
Medicare Advantage. Humana Gold Plus SNP-DE H1036-167 Summary of Benefits
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UNC Health. Insurance Information
6
Watauga Democrat. UNC Health Will No Longer Accept Three Medicare Advantage Plans Effective Jan 1
7
UNC Health Blue Ridge. Medicare Advantage Plan Changes
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North Carolina Department of Insurance. 2026 SNP Plans in Davidson County