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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 Broward, Miami-Dade, and Palm Beach counties. This plan received an overall rating of 4 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 $151.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2450.00 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 $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy used. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy or preferred mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $100 copay for days 1-6, but no copay for days 7 and beyond. Outpatient services have copays between $0 and $150, and emergency services have a $140 copay. The plan covers primary care and specialist visits with a $15 copay and offers preventive services including an annual physical exam with no copay. Hearing, vision, and dental services are included, with hearing exams costing $15, eye exams at $0-$15, and dental services with a $1,000 annual maximum. The plan also covers ambulance, home health, and skilled nursing facility services with no copay. Other services such as acupuncture and over-the-counter items are also covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization; for days 1-6, there is a $100 copay, and days 7-90 have no copay. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $150, and observation services, with a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while individual and group sessions for outpatient substance abuse have a copay between $15 and $25.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with a $15 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services and transportation services. Ground ambulance services have a copay between $0 and $240, and air ambulance services have a 20% coinsurance. Transportation Services have no copay, and are limited to 50 one-way trips per year to a plan-approved health-related location, using a taxi, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a $140 copay, while Urgently Needed Services have a $15 copay, and there is no coinsurance for any of these services. The copay for emergency services is waived if you are admitted to the hospital within 24 hours.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a copay between $15 and $25, Physician Specialist Services with a $15 copay, Mental Health Specialty Services with a copay of $15 for both individual and group sessions, Podiatry Services with a $15 copay, Other Health Care Professional services with a copay between $0 and $15, Psychiatric Services with a $15 copay for both individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a copay between $15 and $25, Additional Telehealth Benefits with a copay between $0 and $15, and Opioid Treatment Program Services with a copay between $15 and $25. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include Medicare-covered services and additional preventive services, with an annual physical exam covered with no copay. Additional services, including fitness benefits, are covered but may have a copay; however, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and other services are not covered.
Hearing Services See details
Hearing exams are covered with a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but the plan specifies a maximum benefit of $750 per year, per ear, and prescription hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a copay of $0-$15, and routine eye exams have no copay. Contact lenses and eyeglasses (lenses and frames) 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 with a $1,000 annual maximum. Medicare Dental Services require prior authorization and a doctor referral with a $15 copay. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Prosthodontics, removable has a 30% coinsurance with no copay. Fluoride treatment, Endodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B insulin drugs, there is a $35 copay and a coinsurance between 0% and 20%, while other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable medical equipment has a 20% coinsurance, while prosthetics, medical supplies, and diabetic supplies have no copay. Diabetic supplies have a 20% coinsurance, and durable medical equipment for use outside the home is not 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 $25, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $150, Therapeutic Radiological Services have a copay up to $25, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by 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 the plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required for this benefit.
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, with a $0 copay for days 1-20 and a $60 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 no copay, and a limit of 25 treatments per year with prior authorization. Over-the-counter (OTC) items are covered, including nicotine replacement therapy and Naloxone, with a maximum benefit coverage amount of $420 per year. A meal benefit is also covered with no copay and prior authorization. Services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others 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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