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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 Broward, Miami-Dade, and Palm Beach counties. This plan received an overall rating of 4.5 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. Additionally, this plan comes with a Part B Premium reduction of $166.00. 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Beneficiaries pay no copay for Tier 1 (Preferred Generic) and Tier 6 (Select Care Drugs) prescriptions through standard retail pharmacies and mail-order services. Tier 2 (Generic) medications also have no copay at standard pharmacies and preferred mail order, though a standard mail-order copay of $10 for a one-month supply applies. For Tier 3 (Preferred Brand) drugs, copays start at $30 for a one-month supply at standard pharmacies and preferred mail-order services. Higher-tier prescriptions require coinsurance, with Tier 4 (Non-Preferred Drug) costing 50% coinsurance and Tier 5 (Specialty Tier) requiring 33% coinsurance. This plan offers a predictable cost-sharing structure to help you manage your healthcare budget when using standard retail or convenient mail-order delivery.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers comprehensive healthcare coverage with many essential services available at no cost to members. You will pay no copay and no coinsurance for primary care doctor visits, preventive care, diagnostic lab tests, and home health services. Routine dental, hearing, and vision services are also covered with no copay for most basic care, alongside generous annual dollar limits for eyewear and prescription hearing aids. For specialized medical needs, inpatient hospital stays require a $100 daily copay for the first six days followed by no copay, and skilled nursing care is free of copays for the first 20 days. Emergency care, specialist visits, and outpatient procedures are covered with low, predictable copayments and no coinsurance. While certain services like dialysis and durable medical equipment require a 20% coinsurance, members can take advantage of extra benefits like over-the-counter items and plan-approved transportation at no copay.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers inpatient hospital services with no coinsurance and a $100 daily copay for days 1 through 6, followed by no copay for days 7 through 90. Prior authorization is required, and some services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services at no copay. Outpatient hospital services require a $0 to $150 copay, observation services carry a $100 copay per stay, and outpatient substance abuse sessions have a $20 to $25 copay.
Partial Hospitalization See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers partial hospitalization services with a $15.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ground ambulance services with a copay of $0 to $240 and applicable coinsurance, and air ambulance services with a 20% coinsurance and an applicable copay. Transportation is partially covered, offering up to 50 one-way trips per year to plan-approved locations with no copay and no 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 $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $15 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation services are all covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Other covered benefits, including mental health, podiatry, and physical therapy, feature copays ranging from $15 to $25 with no coinsurance, though chiropractic services are not covered. Additional telehealth benefits are also available with a $0 to $20 copay and no coinsurance.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are only partially covered; a memory fitness benefit is included with no copay and no coinsurance, but services like health education, in-home safety assessments, PERS, medical nutrition therapy, weight management, alternative therapies, and home-based palliative care are not covered.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Medicare-covered hearing exams with a $15 copay and no coinsurance, while routine exams, fittings, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $750 maximum per ear annually, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers vision services, offering covered eye exams with a $0 to $15 copay and no coinsurance, and covered eyewear with no copay and no coinsurance up to a $300 annual limit. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) up to a $1,000 annual limit, featuring no copay and no coinsurance for most diagnostic, preventive, and restorative services. Medicare-covered dental services require a $15 copay and no coinsurance, removable prosthodontics require a 30% coinsurance and no copay, while fluoride, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, 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 no copay, though prior authorization and step therapy may apply. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a 0% to 20% coinsurance, while Part B insulin has a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers medical equipment with no copays for all covered items, though prior authorization is required. Durable medical equipment and diabetic supplies require a 20% coinsurance, while prosthetics and medical supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, though prior authorization and referrals are required. Members pay no copay for lab services and outpatient X-rays, a $0 to $25 copay for diagnostic procedures and tests, and a minimum $0 copay for diagnostic and therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance. Members will need to obtain both a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, meaning members must pay all costs. There is no copay or coinsurance coverage available for any of the sub-services, including intensive cardiac and pulmonary rehabilitation.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and without requiring a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $60 daily copay for days 21 through 100, and prior authorization is required.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers other services including acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance. Prior authorization is required for the meal benefit and acupuncture, which is limited to 25 treatments per year.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
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