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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 Dallas Area. 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 $200.00 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 $3700.00 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 $200 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you may pay $8 for a preferred generic at a preferred pharmacy, but 40% coinsurance for a preferred brand drug. Specialty tier drugs have no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers a range of benefits, including inpatient and outpatient hospital care, emergency services, and primary care with varying copays. Many preventive services are available with no copay, such as an annual physical exam, and the plan also covers hearing and vision services, with some services having no copay. Dental services like oral exams and cleanings are covered with no copay, and there is coverage for home health services with no copay. Additional benefits include coverage for ambulance services, durable medical equipment, and diabetic supplies with coinsurance or copays, and skilled nursing facility stays with copays. The plan also provides coverage for acupuncture, over-the-counter items, and a meal benefit. However, this plan does not cover some services, such as podiatry, certain dental procedures, and some specific cardiac and pulmonary rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $225 copay for days 1-6, and no copay for days 7-90; Additional Days for Inpatient Hospital-Acute has no copay for days 91-999.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $225, observation services have a $225 copay, and outpatient substance abuse services have a copay between $25 and $50. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but requires prior authorization. There is a $35 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. 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, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Transportation have a $140 copay, while Urgently Needed Services have a $65 copay; all have no coinsurance.
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 with a $20 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services with a $20 copay, mental health specialty services with a $25 copay, and physical therapy and speech-language pathology services with a $25 copay. Additional telehealth benefits are covered with a copay between $0 and $65, and opioid treatment program services are covered with a copay between $25 and $50. Podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers preventive services, including an annual physical exam with no copay. This plan also covers other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay.
Hearing Services See details
Hearing services include coverage for hearing exams with a $20 copay and routine hearing exams with no copay for one exam per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $399 and $999 for all types of hearing aids, but prescription hearing aids for 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 of $0-$20, while routine eye exams have no copay. Eyewear includes contact lenses and eyeglasses (lenses and frames), which have no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Medicare dental services require a $20 copay, and fluoride treatments, prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 16% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance for Medicare-covered services, but Durable Medical Equipment for use outside the home is not covered. Diabetic equipment, including Diabetic Supplies with 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay, are also covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $65, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $325, Therapeutic Radiological Services have a copay of up to $20 and a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), but no cost sharing information is provided. However, the plan does not cover any specific cardiac and pulmonary rehabilitation services.
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, with a $20 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers acupuncture with a $20 copay, up to 20 treatments per year, and also covers over-the-counter items up to $480 per year. The plan also covers a meal benefit with no copay. However, the plan does not cover 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, or Self-Directed Personal Assistance Services.
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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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