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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 2025, 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 Select Counties in Missouri. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $3.00. 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 $250.00 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 $3500.00 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 - Diabetes and Heart (HMO C-SNP) plan has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, you will pay a $5 copay at preferred mail and standard pharmacies, and a $20 copay at standard mail pharmacies. For specialty tier drugs, you will pay no copay.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service. Emergency services have a copay, and primary care has no copay. This plan also includes coverage for preventive, hearing, vision, and dental services, with some services having no copay and others with copays or coinsurance. Other benefits include ambulance, home health, and skilled nursing facility services. This plan also offers additional services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $310 copay for days 1-7, and no copay for days 8-90, with no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $310 copay for days 1-7, and no copay for days 8-90, with no coinsurance. Additional days for Inpatient Hospital-Acute are covered with no copay and no coinsurance. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered, as are additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $350, observation services have a $310 copay, and ambulatory surgical center services and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. You will pay a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a copay of $140.00 for emergency services, and a $65.00 copay for urgently needed services, with no coinsurance. The copay for emergency services is waived if admitted to a hospital within 24 hours. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation also have a copay of $140.00.
Primary Care See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $30 copay, and physician specialist services have a $40 copay. The plan also covers mental health specialty services, psychiatric services, and opioid treatment program services with a copay of $40 for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a copay between $0 and $65. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, have no copay. Some preventive services, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others, are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay. Routine hearing exams are covered with no copay, once per year. Fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids (all types) are covered with a copay between $299 and $599, twice per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $40, and routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses, has no copay, with a combined maximum plan benefit coverage of $300 every year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with specific services like oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services covered with no copay. Restorative services and prosthodontics (removable and fixed) are covered with a 30-40% coinsurance and no copay, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a maximum plan benefit coverage of $1500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance, as well as Diabetic Equipment with a coinsurance of 20% for Medicare-covered Diabetic Therapeutic Shoes or Inserts and a copay for Medicare-covered Diabetes Supplies and Medicare-covered Diabetic Therapeutic Shoes or Inserts. 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 with a copay between $0 and $65, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $350, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan 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 by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and there is a copay for some services, as detailed in the plan's information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. For days 1-20, the copay is $20 per day, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the "Other Services" benefit, Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers acupuncture with a $40 copay, and up to 20 treatments per year. This plan also covers Over-the-Counter (OTC) items, including nicotine replacement therapy and Naloxone, with a maximum benefit of $720 per year. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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* 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.
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