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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 North Carolina. 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 $450.00 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 $9250.00 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) prescription drug plan features an annual drug deductible of $450. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at standard pharmacies or through preferred mail order, while standard mail order costs up to $30 for a three-month supply. Tier 2 generic medications cost as low as a $5 copay for a one-month supply, with no copay for a three-month supply when using preferred mail order. For Tier 3 preferred brands, copays start at $47 for a one-month supply, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 50% and 27% coinsurance respectively. Additionally, Tier 6 select care drugs are highly affordable with no copay across standard pharmacies, preferred mail order, and standard mail order options. These rates vary based on supply duration and whether you utilize standard retail pharmacies or mail-order delivery services.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers robust coverage with no copays for primary care visits, preventive services, and home health services. Specialized care, such as specialist visits and Medicare-covered dental services, requires a $45 copay, while inpatient hospital stays incur a daily copay of $375 for the first seven days. Outpatient services feature no coinsurance and variable copays ranging from no copay up to $450 depending on the specific procedure. This plan also includes valuable supplemental benefits, featuring no copays for routine eye exams, eyewear up to a $200 annual limit, and routine hearing exams. Additionally, dental care is covered with no copay up to a $1,000 yearly limit, and over-the-counter items are available with no copay. For medical equipment and dialysis services, members will pay no copay and a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1-7 of acute stays (no copay for days 8-999) and a $375 daily copay for days 1-5 of psychiatric stays (no copay for days 6-90). This benefit is partially covered, as upgrades, psychiatric stays beyond 90 days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, featuring copays ranging from $0 to $450 for outpatient hospital services and $375 per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay, while outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required and the copay is not waived upon hospital admission. Transportation services are not covered under this plan.
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 $40 copay with no coinsurance, and 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, while specialist visits require a $45 copay and no coinsurance. Additional benefits include physical and occupational therapy for a $25 copay, mental health visits for a $35 copay, and telehealth for a $0 to $45 copay, all with no coinsurance. Chiropractic care is partially covered, but routine and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers preventive services, offering annual physical exams, kidney disease education, and diabetes self-management training with no copay and no coinsurance. Additional services, including fitness benefits, health education, medical nutrition therapy, and personal emergency response systems, are not covered.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), excluding inner ear, outer ear, and over the ear prescription hearing aids. Covered benefits require no deductible and no coinsurance, with a $45 copay for Medicare-covered exams, a $299 to $899 copay for up to two prescription hearing aids, and no copay for routine exams, fitting evaluations, and OTC hearing aids.
Vision Services See details
Vision services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, no deductibles, and prior authorization requirements. One annual routine eye exam, contact lenses, and eyeglasses (lenses and frames) are covered with no copay (up to a $200 yearly limit for eyewear), while other eye exams, individual lenses, individual 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 Medicare-covered dental with a $45 copay and no coinsurance, alongside other covered dental services with no copay or coinsurance up to a $1,000 annual limit. While many preventive and comprehensive services are covered, 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. Related Medicare Part B drugs, including chemotherapy and insulin, require a coinsurance ranging from no coinsurance up to 20%, with insulin drugs specifically carrying 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, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with a 20% coinsurance and no copay. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers diagnostic and radiological services, with prior authorization required. Diagnostic procedures have no coinsurance and a copay ranging from $0 to $120, while lab services and diagnostic radiological services feature no copay and no coinsurance. Outpatient X-rays have no copay but require coinsurance, and therapeutic radiological services carry a minimum $45 copay and 20% coinsurance.
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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) does not cover Cardiac Rehabilitation Services, as all associated sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are listed as not covered. Consequently, there is no coverage, copay, or coinsurance available for these services under this plan.
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, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day 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) partially covers other services, featuring acupuncture with a $45 copay and no coinsurance for up to 20 treatments per year, and over-the-counter items with no copay and no coinsurance. Meal benefits are not covered under this plan.
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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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