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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 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 Select Counties in Missouri. 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 $3300.00 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) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs and Tier 6 select care drugs, you will pay no copay when using standard pharmacies or preferred mail order. Tier 2 generic medications are also highly affordable, starting at a $5 copay for a one-month supply and offering no copay for a three-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, though you can save on three-month supplies by using preferred mail order for a $94 copay. For higher-tier medications, members pay a coinsurance rather than a flat copay, which includes 47% coinsurance for Tier 4 non-preferred drugs and 25% coinsurance for Tier 5 specialty drugs. This plan offers various options to minimize out-of-pocket prescription costs, particularly through the use of preferred mail-order services.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers robust medical coverage with no copay for primary care doctor visits, home health services, and annual preventive care. For hospital stays, members pay a $310 daily copay for the first seven days of inpatient care, followed by no copay for days 8 through 90. Emergency room visits carry a $150 copay, which is waived if you are admitted, while outpatient surgical center services and diagnostic lab tests are available with no copay. Specialty care and supplemental benefits are highly affordable, featuring routine dental and vision exams with no copay, alongside a $1,500 annual dental limit and a $500 yearly allowance for eyewear. Members also benefit from no copay on routine hearing exams, over-the-counter hearing aids, and essential diabetic equipment and supplies. Other specialized services, such as durable medical equipment, dialysis, and Medicare Part B drugs, are covered with a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers inpatient hospital services with no coinsurance and a $310 copay per day for days 1 to 7, followed by no copay for days 8 to 90. Prior authorization is required, and certain services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services carry a $0 to $300 copay, observation services have a $310 copay per stay, and outpatient substance abuse sessions require a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers ambulance and transportation services, as transportation services to health-related locations are not covered. Covered ground ambulance services require a $335 copay with no coinsurance, while air ambulance services require a 20% coinsurance with no copay, with prior authorization required for both.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) emergency services are covered with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, and specialist, physical, and occupational therapy visits with a $30 copay and no coinsurance. While some chiropractic services are covered with a $20 copay and no coinsurance, routine and other chiropractic services are not covered, and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, glaucoma screenings, diabetes training, and memory fitness. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home modifications, and counseling.
Hearing Services See details
Hearing services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), offering Medicare-covered exams for a $30 copay and routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $699 to $999 and no coinsurance for up to two aids per year, though inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers partially covered vision services with no coinsurance, featuring no copay for one routine annual eye exam and up to $500 yearly for contact lenses or eyeglasses. Prior authorization is required, but other eye exam services, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers partially covered dental services with a $1,500 annual limit, excluding fluoride, implants, orthodontics, and maxillofacial prosthetics. Medicare-covered dental services require a $30 copay and no coinsurance, while most other covered preventive and comprehensive services have no copay and no coinsurance, except for prosthodontics which carry no copay and 30% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, insulin, and other drugs require no copay (except for a $35 copay on insulin) and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers durable medical equipment, prosthetic devices, and medical supplies with a 20% coinsurance and no copay. Diabetic equipment, supplies, and therapeutic shoes or inserts are covered with no copay and no coinsurance, though selection is limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers diagnostic services with no coinsurance, offering lab services at no copay and diagnostic procedures with a copay between $0 and $65. Covered radiological services include outpatient X-rays with no copay and therapeutic radiological services with a minimum 20% coinsurance, with prior authorization required for all services.
Home Health Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers cardiac rehabilitation services with no coinsurance and copays ranging up to $30, requiring prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond Medicare-covered services are not covered.
Other Services See details
Other Services under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) are partially covered, offering acupuncture with a $30 copay and no coinsurance, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Highly Integrated Services for Dual Eligible SNPs and other additional services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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