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Humana Gold Plus - Diabetes (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus - Diabetes (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 (HMO C-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus - Diabetes (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. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Plus - Diabetes (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 (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 (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 (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 $2.00. 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 $350.00 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 $7900.00 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 (HMO C-SNP) plan has a $350 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $10 copay at preferred pharmacies. The plan has an "Enhanced Alternative" drug benefit type. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you may have a reduced premium.
Additional Benefits
The Humana Gold Plus - Diabetes (HMO C-SNP) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient services, with copays varying depending on the service. It also covers primary care, preventive services, hearing, vision, and dental services, with specific copays and coverage limits for each. Additional benefits of this plan include ambulance and emergency services, home health services, and skilled nursing facility services. The plan also covers home infusion bundled services, dialysis services, medical equipment, and diagnostic and radiological services. Furthermore, this plan provides coverage for other services such as acupuncture and a meal benefit, with specific requirements and limitations for certain services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by this plan. For Inpatient Hospital-Acute, there is a $390 copay for days 1-4, and no copay for days 5-90, with additional days 91-999 having no copay. Inpatient Hospital Psychiatric also has a $390 copay for days 1-4, and no copay for days 5-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, with varying copays depending on the service. Outpatient Hospital Services have a copay between $0 and $390, Observation Services have a $390 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have copays between $40 and $50, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - Diabetes (HMO C-SNP) plan, with an $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
The Humana Gold Plus - Diabetes (HMO C-SNP) plan covers ambulance services, including ground ambulance services with a $315 copay and air ambulance services with 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Services, are covered under the Humana Gold Plus - Diabetes (HMO C-SNP) plan. Emergency Services have a $110 copay, Urgent Services have a $45 copay, and Worldwide Emergency, Urgent, and Transportation services each have a $110 copay. There is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus - Diabetes (HMO C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $10 copay, and mental health specialty services with no copay for individual and group sessions. The plan also covers podiatry services and other health care professional services, with copays that vary depending on the service, and physical therapy and speech-language pathology services with a $35 copay. Additional telehealth benefits have a copay between $0 and $45, and opioid treatment program services have a copay between $40 and $50.
Preventive Services See details
The Humana Gold Plus - Diabetes (HMO C-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like additional sessions of smoking and tobacco cessation counseling and the fitness benefit have a $0 copay. Other services like health education, in-home safety assessment, and more are not covered.
Hearing Services See details
Hearing exams are covered with a $10 copay, and routine hearing exams are covered with no copay for 1 exam per year. Fitting/evaluation for hearing aids are covered with no copay, while prescription hearing aids have a copay between $699 and $999, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with a combined maximum benefit of $150. Eye exams have a copay between $0 and $10, and routine eye exams, contact lenses, and eyeglasses (lenses and frames) have no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $10 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay; however, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $2,000 every year.
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%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus - Diabetes (HMO C-SNP) plan, but require prior authorization. The plan has a coinsurance of 20% for this service.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have no copay. Diabetic Supplies have a 20% coinsurance and no copay, while 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 coverage for all radiological services, including diagnostic and therapeutic radiological services, and outpatient X-Ray services. Diagnostic Procedures/Tests have a maximum copay of $140, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $390, while Therapeutic Radiological Services have a maximum copay of $20 and a minimum coinsurance of 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus - Diabetes (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 plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus - Diabetes (HMO C-SNP) plan. There is no copay for days 1-20 and days 61-100, and a $214 copay for days 21-60.
Other Services See details
Other Services include acupuncture and a meal benefit, both with no copay, while acupuncture requires prior authorization and has a limit of 25 treatments per year. Other services such as over-the-counter items, 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 are not covered.
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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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