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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 Treasure Coast. 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 $119.00. 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 a $615.00 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 $3350.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 6 select care drugs, there is no copay for a 1-month or 3-month supply when using standard pharmacies or preferred mail order. Tier 2 generic medications are also highly affordable, costing as little as no copay for a 3-month supply through preferred mail order or a $5 copay for a 1-month supply at standard pharmacies. Tier 3 preferred brand drugs require a $35 copay for a 1-month supply at standard pharmacies and preferred mail order. Higher-tier prescriptions require coinsurance instead of flat copays, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. This straightforward cost structure helps beneficiaries clearly understand their out-of-pocket expenses for different medication tiers.
Additional Benefits
The Humana Gold Plus Lung (HMO C-SNP) plan offers comprehensive medical coverage with no copays or coinsurance for primary care, telehealth visits, home health, and preventive services. For specialized care, members can expect a copay of $20 to $35 for specialists and $225 per day for the first six days of an inpatient hospital stay. Emergency room visits carry a $150 copay, which is waived if you are admitted, while urgent care requires a low $15 copay. In addition to core medical care, this plan provides valuable dental, vision, and hearing benefits to help lower your out-of-pocket costs. Most preventive dental services, annual routine eye exams, and routine hearing exams are covered with no copay, though certain medical equipment and dialysis services require a 20% coinsurance. Members also enjoy extra perks at no additional cost, including up to 25 acupuncture visits, chronic illness meal benefits, and over-the-counter item reimbursements.
Inpatient Hospital See details
Inpatient hospital care is partially covered by the Humana Gold Plus Lung (HMO C-SNP) plan with no coinsurance, requiring a copay of $225 per day for days 1 through 6 and no copay for days 7 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus Lung (HMO C-SNP) with no coinsurance, though prior authorization and referrals are required for most care. Under this plan, you will pay a copay of $0 to $250 for outpatient hospital services, $225 per stay for observation services, $20 to $35 for substance abuse therapy, and no copay for ambulatory surgical center and blood services.
Partial Hospitalization See details
Humana Gold Plus Lung (HMO C-SNP) covers partial hospitalization services with a $15.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus Lung (HMO C-SNP) covers ground ambulance services with a copay of $0 to $240 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are not covered in practice because trips to plan-approved and health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus Lung (HMO C-SNP) with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Lung (HMO C-SNP) offers primary care physician services and telehealth benefits with no copay and no coinsurance. Most other covered primary care services, including specialists, physical therapy, and mental health, carry a copay of $20 to $35 and no coinsurance, though chiropractic services are only partially covered since routine and other chiropractic care are not covered.
Preventive Services See details
Humana Gold Plus Lung (HMO C-SNP) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive services are partially covered, offering a memory fitness benefit with no copay and no coinsurance, but excluding coverage for health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus Lung (HMO C-SNP) offers partially covered hearing services, featuring a $20 copay and no coinsurance for Medicare-covered exams, alongside no copay or coinsurance for annual routine exams, fitting evaluations, and unlimited OTC hearing aids. Prescription hearing aids are covered up to $250 per ear annually with no copay or coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus Lung (HMO C-SNP) partially covers vision services with no coinsurance, no deductibles, and eye exam copays ranging from $0 to $20. Covered benefits include one routine eye exam and eyewear (contact lenses or eyeglasses) per year with no copay up to a $50 limit, while other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus Lung (HMO C-SNP) up to a $1,500 annual limit, offering no copay and no coinsurance for most preventive and comprehensive care, a $20 copay and no coinsurance for Medicare-covered dental, and a 30% coinsurance with no copay for removable prosthodontics. Fluoride treatments, endodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Lung (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry a coinsurance ranging from no coinsurance to 20%, while covered insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
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, including durable medical equipment, prosthetics, and diabetic supplies, with a 20% coinsurance and no copay. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus Lung (HMO C-SNP), requiring prior authorization and referrals. Lab services and diagnostic radiology have no copay or coinsurance, diagnostic tests carry a $0 to $150 copay with no coinsurance, and therapeutic radiology requires a minimum $20 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus Lung (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Humana Gold Plus Lung (HMO C-SNP) with no coinsurance, and while some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus Lung (HMO C-SNP) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $60 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus Lung (HMO C-SNP) offers other services with no copay and no coinsurance, including up to 25 acupuncture treatments per year, chronic illness meal benefits, and over-the-counter items via reimbursement. Prior authorization is required for acupuncture and meal services, and certain other miscellaneous services are not covered.
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