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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 Jacksonville Metro and Emerald Coast. 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 $92.00. 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'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy, but a $20 copay if you use standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your cost for Part D drugs is $0.00. Always check the plan's formulary for specific drug coverage details.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers a range of benefits with varying costs. You can expect no copays for services like primary care, preventive services (including annual exams), routine eye exams, and many dental services. The plan also includes coverage for inpatient and outpatient services, with copays ranging from $0 to $250 depending on the service. Additional benefits include hearing and vision services, with no copays for routine hearing exams and eyewear, but with maximum yearly benefit limits. The plan also covers ambulance services, emergency services, and home health services with no copays. Other covered services include dental, home infusion, dialysis, medical equipment, and many diagnostic and radiological services, but copays and coinsurance may apply.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $250 copay for days 1-6, and no copay for days 7-90, and additional days 91-999 have no copay. Inpatient Hospital Psychiatric has a $250 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $200, observation services with a $250 copay, Ambulatory Surgical Center (ASC) services with no copay, and outpatient substance abuse services with a copay between $25 and $75 for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a $45 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have a copay of $0 - $260, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations have no copay, and cover 24 one-way trips per year via taxi, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. Emergency Services has a $90 copay, and Urgently Needed Services has a $25 copay, while all Worldwide Emergency Services have a $90 copay.
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 $25 and $40. This plan also covers Physician Specialist Services with a $20 copay, and Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services, all of which have a minimum $25 copay. Additionally, the plan provides Physical Therapy and Speech-Language Pathology Services with a $25-$40 copay, and Additional Telehealth Benefits with a copay between $0 and $25.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services with copays for certain services, including In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit. Additionally, this plan covers Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $20 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a copay between $199 and $1299 for all types of prescription hearing aids, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Routine eye exams have no copay, and are limited to one per year. Eyewear, including contact lenses and eyeglasses (lenses and frames), has no copay, but a combined maximum plan benefit coverage of $150 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $20 copay, and other dental services with a maximum benefit of $1500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Restorative services, adjunctive general services, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with no copay, while prosthodontics (removable) has 30% coinsurance. Fluoride treatment, endodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while other Medicare Part B drugs have a coinsurance between 0% and 20%.
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's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with coinsurance for Medicare-covered medical supplies and copays for Medicare-covered prosthetic devices, and Diabetic Equipment. 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 include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests and lab services, and a maximum copay of $200 for diagnostic procedures/tests, and no copay for lab services. Radiological Services include coverage for all services, with a copay for Medicare-covered diagnostic, therapeutic, and X-Ray services, a maximum copay of $200 for diagnostic radiological services, a coinsurance of at least 20% and a copay of at least $25 for therapeutic radiological services, and no copay for outpatient X-Ray services.
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. 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 of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD 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 by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $175 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers acupuncture with no copay and a limit of 25 treatments per year, and over-the-counter items with a maximum benefit of $900 per year. The plan also covers a meal benefit with no copay. However, 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 are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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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