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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 Greater Tampa Bay. 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 $160.00. 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 $2400.00 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. In the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, you will pay no copay for preferred generic drugs at a preferred pharmacy or through the mail, but you will pay a $20 copay for standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase. In this phase, you will pay nothing for your 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 copay, but outpatient services may have copays from $0 to $150. The plan also covers emergency services, primary care, preventive services, and home health services, often with no copay. This plan includes coverage for hearing, vision, and dental services, with specific copays and coinsurance amounts. Additional benefits include ambulance services, medical equipment, and diagnostic services, with some services requiring a copay or coinsurance. The plan also offers over-the-counter items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $125 copay for days 1-4 and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan includes coverage for all outpatient hospital services, with a copay between $0 and $150, and observation services with a $125 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a copay between $0 and $10 for individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. This benefit requires prior authorization and has a $35 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. Ground ambulance services have a copay of $0-$200, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location have no copay for up to 50 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $15 copay and no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $10 copay, and Occupational Therapy Services with a copay between $15 and $30. The plan also covers Physician Specialist Services with a $10 copay, Mental Health Specialty Services with a $10 copay, and Podiatry Services with a $10 copay. Other Health Care Professional services have a copay between $0 and $10, Psychiatric Services have a $10 copay, and Physical Therapy and Speech-Language Pathology Services have a copay between $15 and $30. Additional Telehealth Benefits have a copay between $0 and $15, and Opioid Treatment Program Services have a copay between $0 and $10.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, are covered. Annual physical exams have no copay. Additional preventive services and kidney disease education services have no copay. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits have no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $10 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $199 and $1299, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay between $0 and $10, and routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses (lenses and frames) have no copay; however, eyeglass lenses, eyeglass frames, and upgrades are not covered, and there is a combined maximum benefit of $150 per year for all eyewear.
Dental Services See details
Dental services are covered, with a maximum benefit of $2,000 per year. Medicare dental services require a $10 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery have no copay. Prosthodontics (removable and fixed) have a 30% coinsurance, and fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0-20%, while the other drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor's referral, with a coinsurance of 20%.
Medical Equipment See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers medical equipment including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with no coinsurance, and Diabetic Equipment. Diabetic supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay. DME for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $200, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $150, Therapeutic Radiological Services with a copay up to $50 and a coinsurance of at least 20%, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required.
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; however, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. A doctor's referral and prior authorization are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20, and a $150 copay for days 21-100.
Other Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers acupuncture with no copay, and up to 25 treatments per year, but the other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered. This plan also covers Over-the-Counter (OTC) items up to $600 per year, and meal benefits with no copay.
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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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