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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 2026, 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 2026.
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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $3200.00 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 features an annual prescription drug deductible of $615. There is no copay for Tier 1 preferred generic and Tier 6 select care drugs filled at standard pharmacies or through preferred mail order. Tier 2 generic medications cost a $5 copay for a one-month supply, and there is no copay for a three-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with reduced costs for three-month supplies through preferred mail order. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 48% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance. These clear copay and coinsurance structures help you easily project your prescription drug costs under this plan.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan offers comprehensive medical coverage featuring no copay or coinsurance for primary care visits and routine preventive services, while specialist visits require a $30 copay. For hospital care, inpatient stays require a $330 daily copay for the first five days and no copay for days six through 90. This plan also includes essential supplemental benefits, such as routine vision exams and select eyewear up to a $200 annual limit with no copay. Additionally, beneficiaries enjoy preventive dental care up to a $1,000 limit and routine hearing exams with no copay, alongside covered diabetic supplies with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $330 copay per day for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and while unlimited additional acute hospital days are covered with no copay, additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $330 copay per stay for observation services. Ambulatory surgical and blood services are covered with no copay, while individual and group outpatient substance abuse sessions require a $30 to $35 copay.
Partial Hospitalization See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required before you can receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) with prior authorization, requiring a $335 copay and no coinsurance for ground ambulance services, and a 20% coinsurance and no copay for air ambulance services. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO-POS 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 require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits under the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan are partially covered, as chiropractic and podiatry services are not covered. Covered services include primary care physician visits with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) covers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs. This benefit is partially covered, as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) covers hearing services with no deductible, offering annual routine exams, fitting evaluations, and OTC hearing aids for no copay and no coinsurance. Medicare-covered exams require a $30 copay and no coinsurance, while prescription hearing aids are partially covered with no copay and no coinsurance up to $500 per ear annually, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) with no deductibles, no coinsurance, and no copays for yearly routine eye exams and select eyewear up to a $200 annual limit. Prior authorization is required, and certain services are not covered, including other eye exams, individual eyeglass lenses, individual frames, and upgrades.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) offers partially covered dental services up to a $1,000 annual limit, featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for most preventive care. While several comprehensive services require no copay and 30% to 40% coinsurance, fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy, radiation, and other Part B drugs carry no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) 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-POS C-SNP) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies and therapeutic shoes or inserts are also covered with no coinsurance and no copay, though prior authorization is required 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-POS C-SNP), with prior authorization required for services. Lab services and outpatient X-rays require no copay, diagnostic procedures and tests range from a $0 to $90 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) covers some Cardiac Rehabilitation Services with no coinsurance and copays ranging from no copay up to $30, subject to prior authorization. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) covers Skilled Nursing Facility (SNF) services 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 is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) partially covers other services, offering acupuncture for a $30 copay and no coinsurance, alongside over-the-counter items and chronic illness meals with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while dual eligible SNP services and 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
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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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