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Humana Gold Plus Lung (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Lung (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 Lung (HMO C-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus Lung (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 Lung (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 Lung (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 Lung (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 Lung (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 Lung (HMO C-SNP) plan features a $0 drug deductible, meaning prescription drug coverage begins immediately. Beneficiaries will pay no copay for Tier 1 (Preferred Generic) and Tier 6 (Select Care Drugs) across standard pharmacies and mail-order options. Tier 2 (Generic) medications also feature no copay at standard pharmacies and preferred mail-order, though standard mail-order incurs a $10 copay for a one-month supply. For Tier 3 (Preferred Brand) drugs, standard pharmacies and mail-order options require a $47 copay for a one-month supply, while preferred mail-order offers a discounted $94 copay for a three-month supply. Higher-tier prescriptions require coinsurance rather than flat copays, specifically 50% coinsurance for Tier 4 (Non-Preferred) drugs and 33% coinsurance for Tier 5 (Specialty) drugs.
Additional Benefits
The Humana Gold Plus Lung (HMO C-SNP) offers comprehensive medical coverage with predictable, low out-of-pocket costs for essential healthcare services. Members benefit from no copay for primary care visits, while specialist visits and outpatient hospital services carry low copays of up to $150 with no coinsurance. Inpatient hospital stays require a $100 daily copay for the first six days and no copay thereafter, while emergency care features a $150 copay that is waived upon admission. This plan also includes valuable supplemental coverage with no copays or coinsurance for routine vision exams, up to a $300 annual eyewear allowance, and no copays for most preventive and comprehensive dental care up to a $1,000 yearly maximum. Additionally, routine hearing exams, over-the-counter hearing aids, and up to 50 routine one-way transportation trips are provided with no copay. Other essential services like home health care, lab work, and acupuncture are fully covered with no copay, while durable medical equipment and dialysis services require a standard 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus Lung (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $100 daily copay for days 1 through 6 and no copay for days 7 through 90. While unlimited additional acute hospital days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus Lung (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services and a $100 copay per stay for observation services. Additionally, ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $20 to $25 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus Lung (HMO C-SNP) with a $15 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus Lung (HMO C-SNP) with prior authorization, offering ground ambulance services for a $0 to $240 copay and air ambulance services with a 20% coinsurance. Routine transportation is partially covered, offering up to 50 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Humana Gold Plus Lung (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 are covered with a $15 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are available with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Lung (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services feature copays ranging from $15 to $25 with no coinsurance. Chiropractic care is only partially covered, with routine and other chiropractic services not covered by the plan.
Preventive Services See details
Humana Gold Plus Lung (HMO C-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, and memory fitness. Many supplemental services are not covered under this plan, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Humana Gold Plus Lung (HMO C-SNP) covers hearing services, featuring a $15 copay and no coinsurance for Medicare-covered exams, alongside routine exams and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear annually, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus Lung (HMO C-SNP) with no deductibles, no coinsurance, and no copays for covered services, though prior authorization and referrals are required. This benefit includes one routine eye exam per year and up to $300 annually for contact lenses and eyeglasses, while other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Lung (HMO C-SNP) partially covers dental services up to a $1,000 annual maximum with no copay and no coinsurance for most preventive and comprehensive care, though Medicare-covered dental has a $15 copay and no coinsurance, and removable prosthodontics require a 30% coinsurance and no copay. Fluoride treatments, endodontics, implant services, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus Lung (HMO C-SNP) with no copay, although prior authorization is required and step therapy may apply. Covered Medicare Part B drugs, including chemotherapy and insulin, require no coinsurance to 20% coinsurance, with insulin also subject to a $35 copay.
Dialysis Services See details
Humana Gold Plus Lung (HMO C-SNP) covers dialysis services 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 Lung (HMO C-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment and diabetic supplies carry 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 under the Humana Gold Plus Lung (HMO C-SNP) plan with no coinsurance, although prior authorization and referrals are required. Members pay no copay for lab services and outpatient X-rays, a $0 to $50 copay for diagnostic procedures and tests, and a minimum $0 copay for diagnostic and therapeutic radiological services.
Home Health Services See details
Humana Gold Plus Lung (HMO C-SNP) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Humana Gold Plus Lung (HMO C-SNP) offers Cardiac Rehabilitation Services with no coinsurance, but while some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Lung (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, a $60 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by the Humana Gold Plus Lung (HMO C-SNP), offering no copay and no coinsurance for acupuncture (up to 25 treatments per year), over-the-counter items, and chronic illness meals. Prior authorization is required for acupuncture and meal benefits, while other miscellaneous services (Other 1, 2, and 3) and highly integrated dual-eligible SNP 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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