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 Dallas area. 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.
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 $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 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 enjoy no copay on Tier 1 preferred generics and Tier 6 select care drugs when utilizing standard pharmacies or preferred mail order services. Additionally, Tier 2 generic medications are available with no copay for a three-month supply filled through preferred mail order. For higher-tier medications, Tier 3 preferred brands have a $45 copay for a one-month supply at standard pharmacies and preferred mail order. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance across all pharmacy options. Understanding these cost-sharing tiers helps you estimate your out-of-pocket prescription costs with this Medicare plan.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers robust coverage for everyday healthcare needs with affordable out-of-pocket costs. Members enjoy no copay and no coinsurance for primary care visits, preventive services, and routine eye and hearing exams. Specialist visits and Medicare-covered dental services are also highly accessible, requiring only a low $15 copay with no coinsurance. For emergency and hospital care, inpatient stays require a $225 daily copay for the first six days and no copay for days seven through 90, while emergency room visits carry a $150 copay. Additionally, the plan features a $1,500 annual dental limit with no copay for covered services, alongside a $200 yearly allowance for prescription eyewear. Other specialized benefits, such as home health services, are also available with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $225 daily copayment for days 1 to 6 and no copayment for days 7 to 90. Prior authorization is required, and 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, offering no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital visits require a copay between $0 and $225, while individual and group substance abuse sessions have a copay of $20 to $35.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
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 for both. Routine transportation services to plan-approved or other health-related locations are 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, 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, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Other services like therapy, mental health, and telehealth are covered with copays ranging from $0 to $65 and no coinsurance, while podiatry is not covered and chiropractic benefits are only partially covered as routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance for covered services such as annual physicals, kidney disease education, memory fitness, glaucoma screenings, and diabetes training. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission 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 safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers hearing exams with a $15 copay and no coinsurance, while routine exams, fitting evaluations, and OTC hearing aids require no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from no copay to $599, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides partially covered vision services with no coinsurance, no deductibles, and copays ranging from $0 to $15. Covered benefits include one routine eye exam per year with no copay and up to $200 annually for contact lenses or eyeglasses (lenses and frames) with no copay. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $1,500 yearly limit. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay, while associated Medicare Part B drugs, such as chemotherapy, carry a coinsurance ranging from 0% (no coinsurance) to 20%. Medicare Part B insulin is also covered with a $35 copay and a coinsurance ranging from 0% (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, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests have a copay ranging from no copay to $65 with no coinsurance, while therapeutic radiological services require a minimum $20 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no coinsurance and require prior authorization, though only some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Covered services under this benefit carry copayments ranging from $15 to $20.
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 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers other services with no copay and no coinsurance, including chronic illness meals, over-the-counter items via reimbursement, and up to 12 acupuncture treatments per year. Prior authorization is required for acupuncture and meal benefits, while dual eligible SNP highly integrated services and other miscellaneous 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