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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 Counties: LAK, MRN, ORA, OSC, SEM, SUM. 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 $150.00. 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 $3300.00 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 different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, but a $20 copay at a standard mail pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for covered drugs.
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, with no copay for days 5-90, while outpatient services have copays depending on the specific service. The plan also covers primary care visits with no copay, and offers coverage for hearing and vision services. Additional benefits include coverage for ambulance services, emergency services, and dental services, with some services requiring copays or coinsurance. The plan also covers home health services and skilled nursing facilities with copays, and offers an over-the-counter items benefit. The plan does not cover certain services, such as some preventive services, additional hours of care, and specific rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital coverage under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan includes acute and psychiatric hospital stays with a $120 copay for days 1-4, and no copay for days 5-90. Additional days for inpatient hospital acute care are covered with no copay.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $180, observation services have a $120 copay, ASC services have no copay, individual and group substance abuse sessions have a copay between $20 and $100, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but requires prior authorization. The copay for this benefit is $45.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with prior authorization required. Ground ambulance services have a copay between $0 and $260, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, and up to 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $20 copay; all have 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 $20 copay, and Occupational Therapy Services with a copay between $20 and $40. Physician Specialist Services and Mental Health Specialty Services have a $20 copay, while Podiatry Services and Other Health Care Professional services have copays between $0 and $20. Physical Therapy and Speech-Language Pathology Services have a copay between $20 and $40, Additional Telehealth Benefits have a copay between $0 and $20, and Opioid Treatment Program Services have copays between $20 and $100.
Preventive Services See details
Preventive services include annual physical exams with no copay, while additional preventive services, kidney disease education services, and other preventive services have a copay. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $20, and eyewear has no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, periodontics, prosthodontics (removable), and oral and maxillofacial surgery. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, and oral and maxillofacial surgery have no copay. Prosthodontics (removable) has a 30% coinsurance. The plan does not cover fluoride treatment, endodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics.
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 and Other Medicare Part B Drugs are also covered, with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, while Medical Supplies have no copay. Diabetic Supplies have a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $175, Therapeutic Radiological Services have a coinsurance of at most 20% and a copay of at most $50, and Outpatient X-Ray Services have no copay.
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, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
For the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, Skilled Nursing Facility (SNF) services are covered with prior authorization. There is no copay for days 1-20, and a $195 copay for days 21-100.
Other Services See details
Other Services includes acupuncture with no copay, up to 25 treatments per year, and an Over-the-Counter (OTC) items benefit, with a maximum of $540 per year. The plan also covers a meal benefit with no copay, and the following services are not covered: Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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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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