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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 2026, 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 4.5 out of 5 stars in 2026.
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 $171.00. 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 $3100.00 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 features an annual drug deductible of $615. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, you will pay no copay when using a standard retail pharmacy or preferred mail order. Standard mail order options are also available with copays starting at $10 for Tier 1 and $20 for Tier 2 medications. Tier 3 preferred brand drugs have a $30 copay for a one-month supply at standard pharmacies and preferred mail order. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 47% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance. These cost-sharing details help you understand your out-of-pocket expenses for prescriptions under this Humana Medicare plan.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, home health services, and preventive care. For hospital stays, members pay a $120 daily copay for the first four days of inpatient care and no copay for days five through ninety. Emergency room visits require a $150 copay, which is waived upon admission, while outpatient hospital services feature copays ranging from no copay up to $180. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing services, most of which feature no copay. Members receive up to a $1,500 annual limit for dental care, a $300 yearly allowance for eyewear, and up to 24 one-way transportation trips per year at no cost. Additionally, durable medical equipment is covered with a 20% coinsurance, and acupuncture, over-the-counter items, and meal benefits are available with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring a $120 daily copay for days 1 through 4 and no copay for days 5 through 90 for acute and psychiatric stays. Prior authorization is required, and while unlimited additional acute days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, featuring a $0 to $180 copay for outpatient hospital services and a $120 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $20 to $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ground ambulance services with a copay of $0 to $240 and coinsurance, and air ambulance services with 20% coinsurance and a copay. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (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 have a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay per service and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers primary care physician services and select telehealth benefits with no copay and no coinsurance. Other services, including specialist visits, mental health, and physical therapy, are covered with copays ranging from $15 to $40 and no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers partially covered Preventive Services with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and select screenings. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety devices, and counseling services.
Hearing Services See details
Hearing services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, featuring a $15 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams, fitting evaluations, and unlimited OTC hearing aids. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199 to $1,299 for up to two devices yearly, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers vision services with no coinsurance, including one routine eye exam per year with no copay and other exams up to a $15 copay. Eyewear is also covered with no copay up to a $300 yearly limit for contact lenses and eyeglasses (lenses and frames), though separate frames, lenses, upgrades, and other eye exam services are not covered.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers dental services up to a $1,500 annual limit, offering no copay and no coinsurance for most preventive and comprehensive services, while Medicare-covered dental has a $15 copay and no coinsurance. Removable prosthodontics require no copay and a 30% coinsurance, but fluoride, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Humana Gold Plus - Diabetes and Heart (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 - Diabetes and Heart (HMO C-SNP) covers durable medical equipment and diabetic supplies with a 20% coinsurance and no copay, subject to prior authorization. Prosthetic devices require a 20% coinsurance, while medical supplies and diabetic therapeutic shoes or inserts are covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), featuring no copay or coinsurance for lab services and diagnostic radiological services. Diagnostic procedures and tests carry a copay of $0 to $150 with no coinsurance, while outpatient X-rays have no copay, and therapeutic radiological services require a minimum $20 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers home health services with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, though only some services are covered in practice as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $160 copay per day for days 21 to 100. Prior authorization is required, a 3-day prior inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance. Acupuncture is limited to 25 treatments per year, and both acupuncture and meal benefits require prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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