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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 Albuquerque. 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.
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 $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:
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Drug Coverage
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay coinsurance for your prescriptions. During the initial coverage phase, you will pay 25% to 32% coinsurance depending on the drug tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you 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 with varying costs. This plan includes coverage for inpatient and outpatient hospital services, with copays and coinsurance depending on the specific service. Emergency and primary care services are covered, with copays and coinsurance applying, as well as preventive services with no copay for many services. Additional benefits include coverage for hearing, vision, and dental services, with copays and coinsurance. Home health services, medical equipment, and diagnostic services are also covered, with varying cost-sharing. Transportation services, dialysis, and skilled nursing facility services are also included, and the plan covers acupuncture and offers a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. Inpatient Hospital-Acute has a copay of $2050 per admission or stay, with additional days covered at no copay. Inpatient Hospital Psychiatric has a copay of $1950 per admission or stay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center and Outpatient Substance Abuse Services have a minimum of 20% coinsurance. Outpatient Blood Services have 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. 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, and air ambulance services have a $630 copay. Transportation Services to a plan-approved health-related location are covered with no copay, up to 40 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. Emergency Services have a $110 copay. Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, 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, speech-language pathology services, and additional telehealth benefits have a 20% coinsurance, while occupational therapy, mental health specialty services, psychiatric services, and opioid treatment program services also have a 20% coinsurance. Routine foot care has a 20% coinsurance, and other Medicare-covered podiatry services have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services with a copay. This plan does not cover health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered with no copay.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% for routine hearing exams. Fitting/Evaluation for Hearing Aid has no copay, while Prescription Hearing Aids (all types) has no copay.
Vision Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear with no copay, up to a combined maximum of $250 per year. 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 Medicare dental services with 20% coinsurance. Other dental services are covered up to a maximum of $2,000 per year, and oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics fixed, and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, prosthodontics removable, 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 the coinsurance ranges from 0% to 20%. Other Medicare Part B Drugs have no copay, and a coinsurance that ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. You will pay a 20% coinsurance for this service.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME), with a 20% coinsurance and no copay, though DME for use outside the home is not covered. Prosthetic devices and medical supplies are covered, with a 20% coinsurance for Medicare-covered services. Diabetic equipment is covered, with a 20% coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts and a 20% coinsurance and no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $300, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
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, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and coinsurance information is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. 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 C-SNP) plan covers acupuncture with 20% coinsurance, and a meal benefit with no copay. Over-the-counter items are covered, and the plan offers a maximum benefit coverage amount of $2100. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) 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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