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Humana Gold Plus - Diabetes and Heart (HMO-POS 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-POS 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-POS C-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) is a HMO-POS C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Southwest 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-POS 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-POS 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-POS 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-POS 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 $3400.00 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-POS C-SNP)
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Drug Coverage
The Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan has a $250 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, the copay is $5 at a standard or preferred mail pharmacy, but $20 at a standard mail pharmacy. For standard generic drugs, the copay is $47. For preferred brand drugs and non-preferred drugs, you will pay 48% and 30% coinsurance, respectively. The specialty tier has no copay.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan offers comprehensive coverage with varying cost-sharing. You'll find no copay for many services, including primary care, preventive services like annual physical exams, routine hearing exams, vision eyewear, and certain dental and lab services. However, there are copays for inpatient hospital stays, outpatient services, specialist visits, and services like ambulance, hearing aids, and acupuncture. This plan also provides coverage for home health, home infusion, and dialysis services, with some services requiring prior authorization. Additionally, it includes benefits like an OTC allowance, and a meal benefit, but does not cover cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $330 copay for days 1-5, and no copay for days 6-90, with no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $330 copay for days 1-5, and no copay for days 6-90, with no coinsurance. Additional days for Inpatient Hospital-Acute are covered with no copay or coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a $330 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $35 and $40 for both individual and group sessions, and Outpatient Blood Services with no copay. All services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan, and requires prior authorization. You will have a $35 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 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $65 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $140 copay.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services have a $35 copay, and Physician Specialist Services have a $40 copay. Mental Health and Psychiatric Services have a $40 copay, and Physical Therapy and Speech-Language Pathology Services have a $35 copay. Additional Telehealth Benefits have a copay between $0 and $65, and Opioid Treatment Program Services have a copay between $35 and $40. Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services like Glaucoma Screening and Diabetes Self-Management Training with no copay. Some preventive services, such as Health Education and In-Home Safety Assessment, are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a copay between $699 and $999; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered. Prior authorization is required for hearing exams.
Vision Services See details
The Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan covers vision services, including routine eye exams with a copay of $0-$40, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $40 copay, oral exams and dental x-rays with no copay, and other diagnostic services with no copay. Restorative services and prosthodontics, removable, have a 30-40% and 30% coinsurance, respectively, while other services like fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including insulin, chemotherapy/radiation drugs, and other Medicare Part B drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan, with prior authorization required. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance, while Prosthetics and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have a copay between $0 and $90, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $350, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO-POS 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 not covered by the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus - Diabetes and Heart (HMO-POS 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
The Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan covers acupuncture with a $40 copay, and covers Over-the-Counter (OTC) items up to $600 per year. The plan also offers a meal benefit with no copay, and some other 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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