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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 Flagler and Volusia counties. 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 $111.00. 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 $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:
Sign up for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
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Drug Coverage
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) prescription drug plan features an annual drug deductible of $615. Beneficiaries pay no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care) drugs when filled at standard pharmacies or through preferred mail order. Standard mail order for Tier 1 and Tier 2 drugs is available with copays ranging from $10 to $60 depending on the supply duration. For Tier 3 (Preferred Brand) drugs, standard pharmacy and preferred mail order copays start at $30 for a one-month supply. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 (Non-Preferred) drugs carrying a 50% coinsurance and Tier 5 (Specialty) drugs carrying a 25% coinsurance. Choosing preferred mail order can significantly reduce out-of-pocket costs, particularly for three-month supplies of Tier 3 drugs.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive healthcare coverage with no copay and no coinsurance for primary care doctor visits, preventive services, and home health care. For inpatient hospital stays, members pay a $175 daily copay for days one through seven, with no copay for additional days. Specialist visits require a $30 copay, while emergency services have a $150 copay that is waived if you are admitted. Supplemental benefits include routine dental, vision, and hearing exams with no copay, alongside a $2,000 annual dental limit and a $200 eyewear allowance. While medical equipment and dialysis require a 20% coinsurance, other services like acupuncture, meals, and over-the-counter items are covered with no copay. Medicare Part B drugs, including insulin, carry up to a 20% coinsurance with insulin copays capped at $35.
Inpatient Hospital See details
Inpatient hospital care is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring a $175 daily copay for days 1 through 7 and no copay for days 8 and beyond for acute stays. Psychiatric stays share this copay structure up to 90 days, though additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from $0 to $250, outpatient substance abuse sessions have a $35 copay, and observation services cost a $175 copay per stay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), with ground ambulance requiring a $0 to $240 copay plus coinsurance, and air ambulance requiring a copay plus 20% coinsurance. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, while 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, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $15 copay, both with no coinsurance. Worldwide emergency, urgent, and emergency transportation services are also covered under the plan for a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers primary care doctor visits and select telehealth services with no copay and no coinsurance, while specialist, psychiatric, mental health, and podiatry services have a $30 copay and no coinsurance. Physical, occupational, and speech therapies require a copay of $20 to $40 with no coinsurance, opioid treatment has a $35 copay with no coinsurance, and chiropractic services are 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 care, including annual physicals, glaucoma screenings, and diabetes self-management training. While benefits like in-home support and smoking cessation are covered, several additional services such as health education, weight management, nutritional benefits, and personal emergency response systems are not covered.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $30 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $199 to $1,299 and no coinsurance, excluding inner ear, outer ear, and over-the-ear models, whereas over-the-counter hearing aids are covered with no copay or coinsurance.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides partially covered vision services with no copay, no coinsurance, and no deductible, though prior authorization and referrals are required. Eligible members receive one routine eye exam per year and a $200 annual limit for contact lenses and eyeglasses (lenses and frames) combined, while other eye exams, standalone eyeglass lenses, standalone frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers dental services up to a $2,000 annual limit, offering preventive care with no copay and no coinsurance. Medicare dental services require a $30 copay and no coinsurance, while covered comprehensive treatments like restorative and periodontics carry a $25 copay and no coinsurance. Fluoride, endodontics, implants, fixed or removable prosthodontics, maxillofacial prosthetics, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required. Medicare Part B drugs, including chemotherapy and insulin, have 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 for these services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers medical equipment, including durable medical equipment (DME), prosthetic devices, and diabetic supplies, which require a 20% coinsurance and no copay. Medical supplies and diabetic therapeutic shoes or inserts are covered with no copay, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), requiring referrals and prior authorization. Diagnostic procedures and tests require no coinsurance and a $0 to $150 copay, while lab services require no copay and no coinsurance. Therapeutic radiological services require a minimum 20% coinsurance and a minimum $35 copay, while diagnostic radiological services and outpatient X-rays feature no copays.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance, although referrals and prior authorization are required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers skilled nursing facility (SNF) care with no coinsurance and no prior three-day hospital stay requirement. Under this plan, there is no copay for days 1 through 20 and a $160 daily copay for days 21 through 100, with prior authorization required and no coverage for additional days beyond the standard Medicare limit.
Other Services See details
Other services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), featuring acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and other miscellaneous services under this benefit are not covered.
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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