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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 Select Counties in OR, WA. 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 $1.00. 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 $5500.00 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 and Tier 6 select care drugs, members enjoy no copay when using standard pharmacies or preferred mail order. Tier 2 generics are also highly affordable, with no copay for a 3-month supply through preferred mail order and a low $10 copay for a 1-month supply at standard pharmacies. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, which can be reduced to a $94 copay for a 3-month supply when using preferred mail order. Higher-tier medications carry coinsurance costs, with Tier 4 non-preferred drugs requiring a 48% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers robust medical coverage with no copays for primary care visits, preventive services, home health care, and diagnostic lab tests. Specialist visits require a low $15 copay, while inpatient hospital stays incur a $360 daily copay for the first four days followed by no copay. Emergency room visits are covered with a $115 copay, which is waived if you are admitted, and urgent care features a $45 copay. For specialized treatments and equipment, dialysis, durable medical equipment, and Part B drugs carry a 20% coinsurance and no copay. Extra benefits are highly accessible, featuring no copay or coinsurance for routine vision, routine hearing, and preventive dental services, which include a $3,000 annual dental limit and a $500 eyewear allowance. Members also enjoy no copays for acupuncture, over-the-counter items, and chronic illness meals.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $360 daily copay for days 1 through 4 and no copay for days 5 through 90. Prior authorization is required, and sub-services such as hospital upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 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 copays ranging from $0 to $395 for outpatient hospital services and a $360 copay per stay for observation services. Ambulatory surgical center and blood services have no copays or coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $45 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers primary care physician visits with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, as routine and other chiropractic care are not covered. Physical, occupational, and speech therapy services require a $35 copay and no coinsurance, while telehealth is available with a $0 to $45 copay and no coinsurance.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. However, these additional benefits are only partially covered, as services such as health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, featuring a $15 copay for Medicare-covered exams and no copay for routine exams or fittings. Prescription hearing aids are partially covered with a copay between $699 and $999 and no coinsurance, though inner, outer, and over-the-ear types are not covered, while over-the-counter hearing aids are available with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers vision services with no deductible, no coinsurance, and a $0 copay for covered services, up to a $500 annual limit for eyewear. This benefit includes one routine eye exam and one pair of contact lenses or eyeglasses (lenses and frames) per year, while other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), offering a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive services up to a $3,000 annual limit. While many treatments are included, fluoride treatments, maxillofacial prosthetics, implant services, 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 and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copayments and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with prior authorization required. Lab services, outpatient X-rays, and diagnostic radiological services feature no copay, while diagnostic procedures range from a $0 to $140 copay with no coinsurance, and therapeutic radiological services require a minimum $20 copay and 20% coinsurance.
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 is required to receive these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers some Cardiac Rehabilitation Services with no copay, no coinsurance, and prior authorization required. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 45, and no copay for days 46 to 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides partial coverage for other services, offering acupuncture, over-the-counter items, and chronic illness meals with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and certain services, such as Dual Eligible SNPs, 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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