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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 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 Phoenix. 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 $305.00 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 $9250.00 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)
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Drug Coverage
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan features an Enhanced Alternative drug benefit with a $305 prescription drug deductible. After meeting this deductible, you will pay no copay for Tier 1 preferred generics and Tier 5 specialty drugs at standard pharmacies and preferred mail, though standard mail Tier 1 drugs carry a $20 copay. Other tiers require a coinsurance, including 25% for Tier 2 standard generics and Tier 3 preferred brands, and 29% for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. Beneficiaries who qualify for the low-income subsidy, also known as Extra Help, can also reduce their Part D premium to zero.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan provides comprehensive coverage that balances predictable copays with coinsurance for major medical services. Inpatient hospital stays require a set copay per stay with no coinsurance, while outpatient care, primary doctor visits, and medical equipment generally carry a twenty percent coinsurance and no copay. Emergency room visits are covered with a flat copay, while home health services are available with no copay and no coinsurance. This plan also offers robust supplemental benefits to support your daily health, including preventive and comprehensive dental care up to a four thousand dollar annual limit with no copay and no coinsurance. Additionally, members can access routine vision and hearing services, an annual eyewear allowance, and up to forty-eight one-way transportation trips per year with no copay or coinsurance. Over-the-counter items and chronic illness meal benefits are also fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers inpatient hospital services, requiring prior authorization for stays. Acute inpatient care has a $2,050 copay per stay and no coinsurance, while psychiatric inpatient care has a $1,980 copay per stay and no coinsurance; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), with outpatient hospital, ambulatory surgical, observation, and substance abuse services generally requiring prior authorization and carrying a 20% coinsurance with no copay. Outpatient blood services are also covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a 20% coinsurance and no copay. Prior authorization is required to access these covered 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 air ambulance services with a $630 copay, both with no coinsurance. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, and this copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan are covered, generally requiring a 20% coinsurance and no copay for primary care, specialist, and therapy services. Chiropractic services are partially covered, with routine chiropractic care not covered under this plan. Covered podiatry visits have no copay or a 20% coinsurance, while telehealth benefits range from no copay to a $40 copay with a 20% coinsurance.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. However, the benefit is only partially covered, as sub-services such as health education, weight management, in-home safety assessments, and therapeutic massage are not covered.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. Routine exams require no copay and a 20% coinsurance, while covered fitting evaluations, OTC hearing aids, and general prescription hearing aids are available with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers vision services, including one annual routine eye exam with no copay and 20% coinsurance. Eyewear is partially covered with no copay, no coinsurance, and a $400 yearly allowance, though individual 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), which offers a $4,000 annual limit with no copay and no coinsurance for covered preventive and comprehensive services. Medicare-covered dental services require a 20% coinsurance and no copay, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Home Infusion bundled Services with prior authorization. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, other Part B drugs have no copay and no coinsurance to 20% coinsurance, and chemotherapy or radiation drugs require a copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with a 20% coinsurance and no copay. Prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers diagnostic and radiological services with a 20% coinsurance, subject to prior authorization. Copayments range from no copay for lab services up to $40 for outpatient X-rays and diagnostic tests, and up to $300 for diagnostic radiological services.
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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) indicates that some services are covered for Cardiac Rehabilitation, but in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Because these services are not covered, there are no active copay or coinsurance benefits available for them.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers skilled nursing facility (SNF) services with no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance required. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers acupuncture with a 20% coinsurance and no copay for up to 20 treatments per year. Over-the-counter items and meal benefits for chronic illnesses are both covered with no copay and no coinsurance, though highly integrated dual-eligible 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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