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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 2025, 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 out of 5 stars in 2025.
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 $155.00. 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 has no deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and the pharmacy you use. For example, you may pay a $0 copay for preferred generic drugs at a standard pharmacy, or 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and 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. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Humana Gold Plus Lung (HMO C-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. You'll have no copay for primary care visits, routine hearing exams, and many dental and vision services. The plan also covers ambulance and transportation services, emergency services, and offers additional benefits like home health services and coverage for over-the-counter items and meals. This plan includes coverage for preventive services, with no copay for your annual physical exam. It also offers specialized benefits such as hearing and vision care, with coverage for hearing aids and eyewear. You can also expect coverage for diagnostic and radiological services, home infusion services, and skilled nursing facility care, with specific copays or coinsurance amounts depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $100 copay for days 1-6, and no copay for days 7-90, with no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $100 copay for days 1-6, and no copay for days 7-90, with no coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and all additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $150, observation services have a $100 copay, ambulatory surgical center services have no copay, individual and group outpatient substance abuse sessions have a copay between $15 and $25, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus Lung (HMO C-SNP) plan with a $15 copay. Prior authorization is required.
Ambulance and Transportation Services See details
The Humana Gold Plus Lung (HMO C-SNP) plan covers ambulance services, with a copay for air ambulance services and coinsurance for ground ambulance services. Transportation services to a plan-approved health-related location are covered with no copay, up to 50 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $140 copay, Urgently Needed Services has a $15 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are also covered, but may require a copay between $0 and $25.
Preventive Services See details
The Humana Gold Plus Lung (HMO C-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered with a copay, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. You will pay a $15 copay for hearing exams. The plan covers one routine hearing exam and one fitting/evaluation for hearing aids per year with no copay. Prescription hearing aids are covered up to $750 per year, with no copay for prescription hearing aids (all types).
Vision Services See details
Vision Services include eye exams with a copay between $0 and $15, and eyewear with a copay of $0. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, 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 have no copay. Prosthodontics, removable requires a 30% coinsurance. 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus Lung (HMO C-SNP) plan, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with a 20% coinsurance and no copay, and prosthetic devices and medical supplies with no coinsurance and no copay; however, durable medical equipment for use outside the home is not covered. Diabetic equipment, including diabetic supplies and diabetic therapeutic shoes/inserts, are covered with a 20% coinsurance and no copay, with a $0 copay for diabetic supplies and diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $25, and lab services with no copay. The plan also covers diagnostic radiological services with a copay up to $150, therapeutic radiological services with a copay up to $25, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus Lung (HMO C-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus Lung (HMO C-SNP) plan. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus Lung (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 Lung (HMO C-SNP) plan covers acupuncture with no copay, and covers OTC items up to $720 per year. The plan also offers a meal benefit with no copay, and covers meals for chronic illness. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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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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