A non-government entity
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus - Diabetes and Heart (HMO C-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 - Diabetes and Heart (HMO C-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in San Antonio, Corpus Christi, RGV, El Paso Metro. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus - Diabetes and Heart (HMO C-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 - Diabetes and Heart (HMO C-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 - Diabetes and Heart (HMO C-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 - Diabetes and Heart (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $3450.00 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 - Diabetes and Heart (HMO C-SNP)
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 - Diabetes and Heart (HMO C-SNP) prescription drug plan features an annual drug deductible of $615. Beneficiaries can save significantly on lower-tier medications, as there is no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filled at standard pharmacies or through preferred mail order. Standard mail order for these tiers is also highly affordable, with copays starting at just $10 for Tier 1 and $20 for Tier 2. For Tier 3 preferred brand drugs, the plan requires a $45 copay for a one-month supply at standard pharmacies and preferred mail order, or a $47 copay through standard mail order. Higher-tier prescriptions are subject to coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring a 47% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive medical coverage with affordable out-of-pocket costs, including no copay for primary care visits and a low $10 copay for specialists. Inpatient hospital stays require a $95 daily copay for the first five days and no copay for days six through 90, while outpatient hospital services range from no copay up to a $115 copay. Emergency care is available with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also features valuable everyday wellness benefits, including no copays for routine eye exams, routine hearing services, and routine dental care up to a $2,000 annual limit. Members also benefit from no copays on over-the-counter items, chronic illness meals, and up to 60 one-way trips to plan-approved locations. Additionally, essential medical equipment and dialysis services are covered with a 20% coinsurance and no copays.
Inpatient Hospital See details
Inpatient hospital care is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance and a $95 daily copay for days 1 to 5, followed by no copay for days 6 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and both prior authorization and referrals are required.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $115, observation services cost a $95 copay per stay, and outpatient substance abuse sessions have a copay of $20 to $35.
Partial Hospitalization See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services are partially covered with no copay or coinsurance for up to 60 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available for a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $10 copay and no coinsurance. Physical, occupational, and speech therapies are available with a $25 copay and no coinsurance, though podiatry is not covered, and only some chiropractic services are covered since routine and other chiropractic care are excluded.
Preventive Services See details
Preventive services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copays and no coinsurance for annual physical exams, kidney disease education, memory fitness, and screenings like glaucoma, diabetes self-management, digital rectal exams, and EKGs. However, additional preventive services are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Hearing services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no deductible, offering Medicare-covered exams for a $10 copay and routine exams, fittings, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $299 to $599 and no coinsurance, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, no deductible, and no copay for routine exams and eyewear. Covered benefits include one routine exam and a $250 annual allowance for eyeglasses or contact lenses, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, featuring a $10 copay and no coinsurance for Medicare-covered dental services, and no copay or coinsurance for other covered services up to a $2,000 annual limit. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, insulin, and other drugs have a coinsurance ranging from 0% to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with a 20% coinsurance and no copays. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with referrals and prior authorizations required. Lab services have no copay and no coinsurance, diagnostic tests have a $0 to $65 copay with no coinsurance, outpatient X-rays have no copay but require coinsurance, and therapeutic radiology requires a minimum $15 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive this covered care.
Cardiac Rehabilitation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers Cardiac Rehabilitation Services with no coinsurance, meaning some services are covered; however, cardiac rehabilitation and intensive cardiac rehabilitation (each with a $15 copay), as well as pulmonary rehabilitation and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) (each with a $20 copay), are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required, but a prior three-day inpatient hospital stay is not, and additional days beyond the 100-day limit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers acupuncture with a $10 copay and no coinsurance for up to 20 treatments per year, subject to prior authorization. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, while other additional services are not covered.
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