A non-government entity
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 Kansas. 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 $40.90. 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 $590.00 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 $9350.00 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)
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-POS C-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. In the initial coverage phase, you'll pay $5 for preferred generic drugs at preferred mail pharmacies, $47 for standard generic drugs, and $100 for preferred brand drugs. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay of $2,165 per admission, while outpatient services, including blood services, have no copay. Ambulance services have a copay for ground transport and coinsurance for air transport, and emergency services have a $110 copay. This plan covers preventive services with no copay for annual physical exams, and also offers vision and dental coverage. Hearing exams and routine hearing exams have no copay, and prescription hearing aids have a copay. Dental services have a $4,000 maximum annual benefit. Other benefits include home health services with no copay, dialysis services with 20% coinsurance, and durable medical equipment with 19% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan. For Inpatient Hospital-Acute, there is a copay of $2,165 per admission or stay, and additional days are unlimited with no copay per day. Inpatient Hospital Psychiatric has a copay of $2,016 per admission or stay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse have a minimum and maximum coinsurance of 20%. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services and Urgent Coverage, are covered under the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan. Emergency services have a $110 copay, while Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy, Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance. Chiropractic Services, Individual Sessions for Mental Health, Group Sessions for Mental Health, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services all have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
The Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are also covered, and some services may have a copay.
Hearing Services See details
The Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan covers hearing exams with at most 20% coinsurance, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $699 and $999 per year, while inner ear, outer ear, and over the ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision Services include eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance and a copay for some services. Routine eye exams have no copay, and contact lenses have no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $4,000 maximum benefit per year. Medicare Dental Services are covered with 20% coinsurance, while other dental services cover oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Fluoride treatment, maxillofacial prosthetics, implants services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is no copay, and the coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
The Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan covers Durable Medical Equipment (DME) with 19% coinsurance, and also covers Prosthetics/Medical Supplies with 20% coinsurance. Diabetic supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services, are covered. Diagnostic procedures/tests and lab services have a coinsurance of at most 20%, with lab services also having no copay. Diagnostic radiological services have a coinsurance of at most 20% and a copay of at most $350, with a minimum copay of $300. Therapeutic radiological services and outpatient X-ray services both have a coinsurance of at most 20%.
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 under the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan with prior authorization required. There is no copay for days 1-20, and a $214 copay per day for days 21-100.
Other Services See details
For the Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) plan, Other Services includes acupuncture with 20% coinsurance, and a meal benefit with no copay. This plan also covers over-the-counter items with a maximum benefit of $1800 per year. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others 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